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New Patient Form

If this is your animal's first time at one of our Northwest Animal Eye Specialists veterinary clinics, please complete our New Patient Form via any one of the following methods.

Book An Appointment

My Pet Needs an Appointment

We book all appointments based on urgency, so it is essential that you fill out this form in its entirety in order for us to help you and your pet. Once you submit your information, you must contact your veterinarian(s) immediately and have them send your pet's medical records to us. Once we receive your pet’s records, our staff will review those as well as the information you've submitted in this form and will get back to you via email or phone within 2-3 business days or less with options for scheduling an appointment. Even if your pet’s issue is urgent, please fill out this form and rest assured that we review this information as soon as it is submitted. We are currently booking out by roughly 1-2 months for non-urgent new patient appointments. If your pet has not seen a vet for this issue or if we do not receive records, your pet may be booked for our next available appointment. We recommend you use Google Chrome, Safari, or Mozilla Firefox to fill out this form. Please call us if you need assistance filling out this form.

Owner Information

Emergency Contact

Patient Information


Consent for Treatment and Hospital Policies

WELCOME TO OUR PRACTICE
We are pleased to have the opportunity to work with you and your pet. We hope that this handout will provide you with information that will be helpful in making an informed decision regarding the services we can provide. It is very important for you to carefully read this agreement and any other handouts that we may provide you so we can discuss any questions you may have. We love working with animals and we strive to treat your pet, as we would want our pets treated. Our own pets are our children thus we can really relate to how much concern and anxiety you might be feeling about your pet’s eye problem. We have an extremely skilled and caring staff that will work with us to take care of you and your pet.
APPOINTMENTS
So that we may devote 100% of our time and energy to you, we do not “double book” appointments as some doctors do to circumvent problems with last-minute cancellations. Your appointment time is held exclusively for you. If you fail to show up for your appointment or cancel at the last minute, there is an open appointment slot when another pet could have been examined. There are many concerned pet owners just like you that are anxious to have their pet evaluated as soon as possible. If you will not be coming for your appointment, we ask that you give us at least 24 hours notice so that another client and pet may take your appointment time. You may be charged for the appointment without such notification.
PAYMENT POLICIES AND FEES
The fees you can expect to pay are as follows: New patient examination: $513.49. All new patients are required to pre-pay $125.00. This will be recorded as a credit in your pet's record and applied towards the new patient exam fee at the time of the scheduled appointment. If the appointment is completely canceled and not rescheduled the pre-payment will be refunded to the credit card it was charged to. Recheck examination: $267.98 After Hour Emergency examination (for current clients only): $696.07 -
$816.86* We require a 50% deposit before we proceed with emergency surgeries. *Price dependent upon how many staff members we need to call in in order to care for your pet. The fees allow for inclusion of the following tests that might be performed as part of the assessment: tear testing, intraocular pressure testing, and fluorescein staining. The examination fee does not include more advanced diagnostic testing, medications, or procedures. Emergency examinations may cost extra. Please ask BEFORE the examination if you have questions. There is only one occasion where recheck exams are at no charge and that is the first recheck exam after a surgery. ALL other recheck exams (after appointments or surgery) have an associated fee as indicated above.
PAYMENTS FOR SERVICES PROVIDED FOR YOU AND YOUR PET IS EXPECTED AT THE TIME SERVICES ARE RENDERED.
Acceptable forms of payment include cash, check, American Express, debit, Discover, Visa, or MasterCard. We do not accept payment plans. For larger invoices, you have the option of applying for financing through Care Credit. It is a third party form of financing that does not have finance charges so long as you pay off the balance within 6 months. Insured Pets: You are still responsible for payment on your account at the time of service. Insurance reimbursement is between the insurance company and the insured. Overdue Accounts: Overdue accounts may be turned over to a collection agency, an attorney, and/or small claims court. You will be responsible for attorneys’ fees/costs or collection agency fees in the event your account becomes delinquent. Payments returned from your bank due to non-sufficient funds will be subject to a returned check fee of $40.00 for each item returned.
DAY HOSPITALIZATION
If your pet is left for a procedure, surgery, or examination, we ask that you return for your pet by the time the hospital closes at 5 PM, unless other arrangements have been made. If you have not returned by closing, your pet might be transferred to an emergency hospital for overnight hospitalization and treatments. Should this be necessary, you will be responsible for fees incurred at the emergency hospital.
EMERGENCIES AND HOW TO CONTACT US
We are usually in the hospital between 9 AM and 5 PM Monday through Thursday. However, we cannot take telephone calls if we are in surgery or in with a client. We have a very capable staff that is eager to help you. They can usually take care of your questions or concerns. If not, they will leave us a message and your call will be returned at our earliest availability. In the event of an after hours emergency, you should call the hospital for instructions on how to reach us. If we cannot be reached immediately and you feel that your pet has an urgent problem, you should call your regular veterinarian or an emergency hospital.
MEDICAL RECORDS
Your pet’s medical records are confidential. Information about your pet’s eye problems will not be released to third parties without your specific consent. There is one exception. We will fax a copy of the eye examination report to your regular/referring veterinarian unless you voice an objection to us. If for some reason you do not want your vet to see the examination report, please bring it to our attention before the examination. Keep in mind that we try to work as part of a health care team with your regular veterinarian.
INFORMED CONSENT
Your signature below indicates you have read the information in this document, that you understand it, and that you agree to abide by its terms during our professional relationship. If you have any questions, please feel free to discuss them with my staff prior to signing this agreement.

New Patients Welcome By Referral

Northwest Animal Eye Specialists is accepting new patients! Our experienced vets are passionate about the eye health of animals. Talk to your vet today about getting a referral to our Renton or Kirkland clinics.

Contact Us

Kirkland Renton