This form is for patients with a CURRENTLY scheduled appointment. If you have not yet scheduled an examination, please follow this link to request an appointment. 

    Client Information 

    Permissions
    Veterinary Vision of Rochester Hospital Policies
    • For your protection, and that of others, pets should be properly restrained by a leash or carrier upon arrival. Do not address or reach for another pet within the facility without first obtaining permission from its owner(s). Many of our patients are here due to illness and are not always feeling up to the affections of others.
    • Veterinary Vision of Rochester operates primarily by appointment. We are available to see patients on a limited emergency basis, however, these services WILL be subject to a higher fee schedule. As such, we request all our clients to be on time for scheduled appointments and procedures. If you must cancel an appointment we ask for 72 hours notice. FAILURE TO CANCEL WITH MORE THAN 72 HOUR NOTICE WILL RESULT IN A FORFEIT OF YOUR DEPOSIT. 
    • Veterinary Vision strives to provide prompt, timely service. Your on time arrival helps us to maintain patient visit flow and maximize the number of patients we are able to help. We understand that unforeseen circumstances may cause you to arrive later than your appointment start time. Veterinary Vision offers a 5 minute grace period. Should you arrive for your scheduled appointment time after 5 minutes late (but less than 15 minutes) a late fee of $50 will be applied to the appointment. Should you run late by 15 minutes or more, you will be asked to reschedule your appointment or be charged an emergency exam fee.
    • Your appointment today may result in the administration of medications(s). Many of these may need to be refilled. We are happy to call those into local pharmacies, or make them available for you to pick-up from our facility. We ask for 48 hours notice prior to picking up those requested prescriptions whenever possible. 
    •  I understand that Veterinary Vision does not offer third party billing. In the event you are electing to use pet insurance, it is the responsibility of the policy holder to verify coverages prior to your visit. Veterinary Vision of Rochester is not able to alter completed records or invoices. 

    By checking below I, the above named client, assume responsibility for all charges incurred in the care of my pet(s). I understand that full payment is due a the time services are rendered. In the event that payment in full is not made, I understand that I will be responsible for all service and attorney fees incurred in the attempt to collect payment.

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