Membership Form for Preventive Care Plan for Cats

1. This Contract (the "Plan") is an agreement between Animal Care Clinic (“Provider”) and the person signed below (“Subscriber”).*

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2. The membership fee ($39 for the first patient and $34 for each additional patient) and first monthly payment are due immediately upon Subscriber signature. Plan becomes effective upon receipt of payment.*

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3. The selected plan only covers the included services described below. It only covers services performed by Provider. Plan does not cover any fees for services intended to treat an illness or accidental injury.*

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All Preventive Care Plans for Cats include two comprehensive wellness examinations and consultations with a Veterinarian, no more than one each of the following vaccinations (Respiratory/Panleukopenia, Rabies), an Interstate Health Certificate, Complete Blood Count, Intestinal Parasite Screen, and unlimited office visits and telehealth consultations. The Essential Plan ($21/month) also includes an essential chemistry panel and a 10% Out-Of-Plan Discount. The Outdoor Plan ($27/month) also includes a Leukemia vaccination, a FeLV/FIV Screen, and a 10% Out-Of-Plan Discount. The Optimum Plan ($36/month) also includes a complete urinalysis, thyroid screen, comprehensive chemistry panel, proBNP heart health screen, cPL pancreatitis screen, two blood pressure assessments, and a 15% Out-Of-Plan Discount.

4. Plan shall be effective for one year beginning on the date payment is received. Plan will be automatically renewed unless canceled by either party with 30 days' notice. No renewal fee will be charged unless Subscriber changes payments to monthly recurring.*

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5. Plan is not transferable and applies only to Patient identified below at the time of enrollment for as long as the patient is owned by the same subscriber. Services are included only at Provider.*

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6. If Subscriber cancels before any services are rendered, the entire amount paid for the current year will be refunded, minus the Membership Fee and 5% of all payments collected to cover credit/debit card processing and administration fees.*

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7. If Subscriber cancels after any services are rendered, Provider retains the entire amount of the membership fee and all monthly payments.*

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8. If Subscriber cancels for any reason including, but not limited to, death of patient or change of provider after any included services are rendered, Subscriber will be liable to the provider for remaining installments for the year or the full amount of the standard price of all services rendered while subscribed to the plan—whichever is less.*

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9.There are no refunds from any prior year.*

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10. Subscriber can pay Provider in full or opt to make automated recurring monthly payments. If paying in full for the plan year, the membership fee will be waived.*

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11. Automated recurring monthly payments are to be made with a credit/debit card. Subscriber is responsible for notifying Provider if there are any changes to the credit/debit card including, but not limited to, expiration of the card. Subscriber authorizes Provider to store a credit/debit card of Subscriber and charge the card to collect recurring monthly payments or any amount that is unpaid.*

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12. Provider reserves the right to adjust monthly fees on membership anniversary date and to cease to provide the plans at any time.*

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13. Unlimited Office Visits apply to regular office hours only. Provider reserves the right to charge additional fees if any treatment of Patient causes principals of Provider to work beyond regular office hours. Subscriber must schedule an office visit. At Provider's discretion, Subscriber may be asked to admit Patient with Provider to provide care. In this case, Subscriber must allow at least 6 hours for Provider to care for Patient. At Provider’s discretion, additional fees may be warranted if Patient is admitted to Provider.*

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14. If Subscriber fails to pay any installment within 30 days of the due date, Provider may immediately terminate the agreement and/or declare all fees and remaining monthly payments due to year end immediately due and payable.*

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15. If Subscriber restarts any Plan after termination, Subscriber must re-apply and pay the membership fee.*

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16. If Subscriber fails to keep a scheduled appointment or cancels a scheduled appointment within 3 hours of the appointment, Subscriber may be subject to a $20 cancellation fee. Cancellation fee must be paid to receive services from Provider.*

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17. All lab tests are grouped together and will be sent to our lab on the same day. If Subscriber prefers the tests separated, an additional charge may apply. If Provider determines additional procedures or sedation is required to collect lab samples or perform routine preventive care, an additional fee will apply.*

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18. Out-of-Plan Discounts do not apply to products purchased through our third-party online pharmacy provider. Out-of-Plan Discounts do not apply to therapeutic or retail diets. Other products and services may be excluded from the Out-of-Plan discount at the discretion of Provider.*

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19. If Provider is unable to provide veterinary care for the Patient during regular office hours for any reason, Subscriber agrees not to pursue any legal or financial recourse.*

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20. In the event of a default of this contract by Subscriber, Provider shall be entitled to collect from Subscriber all costs incurred in attempt to collect payment, including reasonable attorneys’ fees.*

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I have read, understand, and agree to the terms of this contract and am at least 18 years old. The membership fee and first monthly payment is due immediately upon Subscriber signature. Plan becomes effective upon receipt of payment.*

I agree

Patient's Name*

Choose a Preventive Care Plan*

Essential Plan for Cats ($21/month)
Outdoor Plan for Cats ($27/month)
Optimum Plan for Cats ($36/month)

I intend to:*

Pay monthly
Pay in full up front and have the $39 one-time membership fee waived

If paying monthly, the monthly payment will be charged on the following day:*

1st of each month

A credit card will be stored and encrypted during your visit. Your card will be charged the monthly fee on the first of each month.

Subscriber's Legal Name*

First Last

An electronic signature appearing on this Contract is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.*

I agree

Signature

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Membership Form for Preventive Care Plan for Cats

Preventive Care Plan for Cats Agreement

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