Client Forms

Contact Us 503-246-9689

Please complete our new client form prior to your appointment. You may fill out the web form below, or download the fillable PDF option and email it to the hospital.

CANCELLATION POLICY

Appointments must be modified a minimum of 48 hours (excluding weekends) prior to your appointment start time. We reserve the right to collect a security deposit, up to the value of an exam fee, in instances of multiple and/or short notice cancellations.


  • Primary Contact Information


  • Secondary Contact Information



  • Referring Veterinarian Information


    Please list all referring veterinarians with which we should share our findings.

  • Pet Insurance Information


  • We use Trupanion Express for Trupanion clients, or we keep a signed, undated claim form to submit on your behalf.

  • Patient Information



  • Patient History Information


  • Please include dosage information, including strength and directions for administration.

  • Patient Diet Information



  • CPR/DNR Release



  • New Client Policies


    Please read the following client policy statements and agree to the terms and conditions below. You may also download the Client Policy Form directly by clicking the button below.

  • Download the New Client Policy Form

  • CANCELLATION POLICY

    Appointments must be modified a minimum of 48 hours (excluding weekends) prior to your appointment start time. We reserve the right to collect a security deposit, up to the value of an exam fee, in instances of multiple and/or short notice cancellations.

    FINANCIAL POLICY

    Payment is due in full at the time services are rendered. We do not offer billing or in-house payment plans/financing. We strive to provide estimates for all services before performing them. Sometimes in a hospitalization or emergency event it is difficult to give an accurate estimate. Please tell us if you have specific cost concerns. We accept cash, check, VISA, MasterCard, Discover Card, American Express, and CareCredit.

    PRESCRIPTION POLICY

    To best serve your pet’s changing needs, we require regular recheck examinations for prescription approvals. Rechecks are recommended per the severity of your pet’s cardiac disease and are generally less expensive than the initial visit. We cannot accept returned prescriptions for a refund once they have left our hospital, but we will gratefully accept them as a donation to use in cases where the owners cannot afford care.

    "A Veterinary-Client-Patient Relationship (VCPR) must be in place for a veterinarian to be able to legally provide treatment, prescribe medications, or administer vaccines to an animal. The veterinarian must have examined the animal within the last year in order to establish the VCPR." - Oregon Veterinary Medical Association (OVMA).


  • PHOTO POLICY

    Cardiology Northwest may publish photos of me and/or my pet for educational and promotional purposes including the business website, Facebook, Instagram, Twitter, and/or publications.
  • Once you submit this form you will receive an email from info@heartvet.com confirming its completion. If you do not receive an email, please call our office for confirmation before your scheduled appointment.
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