Adult Canine Wellness Package Consent Form

    I, , the legal owner and guardian of understand that the Adult Wellness Package includes the following items:
    • Rabies Vaccine
    • Distemper Parvo Vaccine
    • Leptospirosis Vaccine
    • CIV Vaccine
    • Bordetella Vaccine
    • (2) Pyrantel Dewormings
    • (1) Fecal Test
    • Annual Heartworm Test
    • Annual Blood work (SuperChem/Lytes/CBC/UA/T4) with Cystocentesis
      • Which includes full blood panel, urinalysis, and thyroid test
    • Unlimited exams/office calls for one year
    • 10% Discount on annual Dental Prophylaxis and Dental Radiographs
    • 10% Discount on biannual Proheart injection for heartworm prevention
    • 10% Discount on Bravecto flea and tick prevention
    • All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.
    Furthermore, I understand the following conditions of purchase of this package:
    • I can purchase the package up to seven days after this pet’s first visit to have the covered services credited toward the purchase of the package.
    • This package is non-transferable between pets, but can be transferred to a new owner of the patient listed.
    • The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
    • The 10% discount on dental prophylaxis and dental radiographs (1) does not include blood work, medications to go home, or extractions and (2) only applies if the dental package is purchased (pre-anesthetic panel, dental prophylaxis, and full mouth preventative dental radiographs).
    • If I fail to bring my pet in for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) they may require.
    • The Adult Wellness Package is valid for one year from date of purchase, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.
    Please sign here: