8250 SW Tonka St. | Tualatin, OR 97062

(503) 246-9689

Mon, Tue: 7:30am - 5:30pm, Wed, Thu: 7:30am – 4:30pm

Open Mon-Fri: 5PM to 10PM, Sat: 12PM to 8PM, Sun: 12PM to 6PM

New Client Form 503-246-9689
New Client Form 503-246-9689

Our Hospital Remains Open With Modified Operations To Keep You and Your Pets Safe.COVID-19 Updates

Client Forms

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.

Cardiology Northwest New Client Form

Please complete our new client form prior to your appointment. You may complete this form via the web form below or by downloading the PDF and emailing it to us directly.

How to submit your new client form by Email:

  1. Open the fillable PDF version of the new client form by clicking the button below.
  2. Download the blank form to your computer. DO NOT fill the form out in your browser. The data will not save.
  3. Complete the fillable PDF form using your computer’s PDF reader program.
  4. Save the completed form as a new file and email it to the hospital as an attachment.

If you have any questions or issues with the form, please call us at 503-246-9689.

Download New Client Form

  • 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


    For patients with suspected or diagnosed heart disease, it’s appropriate to decide in advance whether aggressive measures of resuscitation (CPR) will be performed if needed. In the event of cardiac or respiratory arrest, we will always default to performing CPR unless otherwise noted. This may include chest compressions, administration of emergency drugs, intubation (placing an endotracheal tube into the trachea to administer oxygen), or other emergency measures.

  • If you DO NOT wish us to attempt to resuscitate your pet in the event of cardiac or respiratory arrest, please initial below:

  • New Client Policies

    Please read the following client policy statements and agree to the terms and conditions below.

  • 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 (our legal requirements are noted below). 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.
  • Max. file size: 8 MB.
  • 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.

  • If you are unable to submit this form, be sure to go back and ensure that you have completed all the required fields (those with the red asterisk). You will not be able to submit the form if there are missing fields.