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New Client Registration

At Battlefield Animal Clinic, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

New Client Registration Form

We have a referral program; we want to thank them!

Client Information

Thank you for entrusting us with the care of your pet(s). So that we may be better able to meet your needs, please complete the following information:

Date of Visit

Name

Address

Home Phone

Cell Phone

DL#

S.S. Number (last 4 digits)

Date of Birth

Employer

Work Phone

Employer's Address

Emergency Contact Information

Emergency Contact

Relationship to Client

Address

Phone

Are they authorized to make medical/financial decisions on your behalf? Yes No

Are they 18 years of age or older? Yes No

Our clinic accepts Cash, Visa, MasterCard, American Express and Debit cards in addition to Care Credit and Scratchpay. We DO NOT accept personal checks. Unlike our counterparts in human medicine, we receive no financing from state or federal agencies, nor do we receive support from insurance companies or charities. It is for this reason that we require payment in full at the time services are rendered so that we can continue to operate a state of the art facility and provide your pet(s) with optimum health care. Deposits may be required for major medical/surgical cases or trauma and emergency work where hospitalization is required.
Financial Responsibility Agreement

I understand that if in the event my account becomes past due (over 30 days) a monthly Statement Handling Fee of $5 will be applied to my balance monthly and after 60 days an additional 2% service fee will be applied monthly. I understand that if my account becomes past due (over 90 days) and all attempts to arrange payment have failed, it will be turned over for collection. I also understand that I will be responsible for all applicable collection or attorney’s fees and all other costs expended to collect said amount. I also understand if in the event I pay by check* and it is returned for insufficient funds, I will be charged a fee of $35.00.

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Patient Information

Name

Species (K-9, Feline, Other)

Breed

Date of Birth

Has your pet been spayed or neutered? Yes No

If yes, date performed

Is your pet currently on medication(s)? Yes No

If yes, please list

Does your pet have any health issues or concerns?

When was the last time your pet was treated by a veterinarian?

Name of previous veterinarian and clinic

Is your pet current on vaccinations? Yes No

Office Hours and Staffing

Battlefield Animal Clinic has business and medical staffing hours as follows:

Monday through Friday 6 AM to 7 PM
Saturday 8 AM to 2 PM
Sunday NO OFFICE HOURS

We typically have no continuous medical staff for the following hours:

Overnight: Closing 7 PM to opening 6 AM
Weekends:Closing Saturday 2 PM to Monday 6 AM
Holidays: Closing time to opening day after holiday at 6 AM
1st Staff Meetings: 2nd and 4th Thursdays each month from 12 PM to 2 PM

Medical staff will be on-hand at these times on an “as needed” basis for any cases requiring continuous medical treatment. In the event of after-hours emergencies, please call the MedVet Emergency Hospital in Manassas at (703) 361-8287. The MedVet Emergency Hospital provides after-hours emergency care for our clients and will advise us of any emergency visits by our clients

E-signature

Date

Contact
us

Office hours  & location

Monday

6:00 am - 7:00 pm

Tuesday

6:00 am - 7:00 pm

Wednesday

6:00 am - 7:00 pm

Thursday

6:00 am - 7:00 pm

Friday

6:00 am - 7:00 pm

Saturday

8:00 am - 2:00 pm

Sunday

Closed

Battlefield Animal Clinic
8138 Sudley Road
Manassas, VA 20109

Phone: (703) 361-0271

Fax: (703) 361-2265

Emergency / After Hours

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We help pets overcome pain and regain their mobility, providing personalized care solutions to help them get back to doing what they love quickly and effectively.

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OUR LOCATION

8138 Sudley Road
Manassas, VA 20109

(703) 361-0271