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Please fill out form and bring form in to South Fulton Pet Care to complete your activation of your plan. Plan will not go into effect until pet has been physically examined by a veterinarian and all documents are duplicated/signed by the client and a staff member of South Fulton Pet Care, LLC.
Dr. Regina Hyde-Nance, DVM
SOUTH FULTON PET CARE
WELLNESS PLAN AGREEMENT
South Fulton Pet Care,
5370 Campbellton-Fairburn Road, Suite 440, Fairburn, Georgia 30213,
( hereinafter referred to as “SFPC”)
SFPC is a full-service animal hospital whose mission is to provide friendly, informative, and supportive services to the highest standard of veterinary care for you and your pets.
SFPC desires to provide members and their pets’ annual preventative care in a cost effective and affordable manner.
Scope of Services
SFPC agrees to provide member’s dog or cat the following services:
1) Annual and biannual vaccinations
2) Annual heartworm test
3) Biannual fecal evaluation
4) Free examinations for one year
5) 4 Free Anal sac expressions
6) 4 Free Nail Trims
8) One ear swab examination
9) 5-10% discount on diagnostic testing (based on plan level)
10) Two dewormings
11) Blood work and Urinalysis
12) Radiographs (Special Plan)
13) Spaying and Neutering (Complete Puppy Plan)
14) Dental Cleanings (Complete Adult Plan)
Terms and Conditions
The term of this agreement shall begin on ______________________, 201__, and shall continue until _______________________, 201___, unless sooner terminated as stipulated in the terms and conditions section.
1. The plan covers all services listed and only those services. It doesn't cover:
2. The plans are not transferable and apply only to the patient identified at the time of enrollment for as long as it is owned by the same owner. Services are good only at this hospital.
3. If the subscriber cancels before any services are rendered, the entire amount paid for the current year will be refunded, minus the sign-up fee. Refund to member will occur within 14 days of SFPC receiving written notice of cancellation.
4. If the subscriber cancels after any services are rendered, the provider retains the entire amount of the sign-up fee and all monthly payments.
5. If the subscriber cancels after any services are rendered, the subscriber will be liable to the provider for remaining installments for the year or the full amount of the standard price of services already rendered—whichever is less.
6. There are no refunds from any prior year.
7. The subscriber can pay the veterinary practice monthly or in full. If paying in full, the subscriber will receive an additional 10% discount.
8. If the pet dies or the subscriber moves, the subscriber will pay the balance of payments or the standard price for services rendered—whichever is less.
9. Multi-pet families must have similar pets identified with microchips or with tattoos, unless all similar pets are covered under wellness plans.
10. The contract will be automatically renewed unless canceled by either party with 30 days' notice. No sign-up fee will be charged with renewal.
11. The provider (SFPC) reserves the right to adjust monthly fees on any enrollment anniversary date and to cease to provide the plans at any time.
12. Unlimited office calls apply to regular office hours only. All services will be rendered during scheduled drop-off appointments, when the patient is left by the subscriber at the hospital for at least four hours. Holidays and weekends are not available for drop-off appointments.
13. Payments will be auto-deducted from most debit or credit card accounts. An overdraft and reprocessing fee of $25 will be charged for any rejected charges.
14. The subscriber is responsible for notifying the provider if there's a change in the account.
15. If the subscriber fails to pay any installment within 30 days of the due date, the provider may:
> Immediately terminate the agreement.
> Declare all fees and remaining monthly payments due to year end immediately due and payable.
16. If the subscriber restarts a wellness program after termination, he or she must re-apply and pay the membership sign-up fee. Clients have an 72hrs grace period to reactivate plan without additional charges. Sign up fees also applies to clients that allow plan to become deactivated due to lack of payment. Re-enrollment will be on a case by case basis. Clients that cancel plan, then request reactivation after 30 days, will have a 90 day grace period before plan can be reactivated.
17. Dental and surgical services will have a 6 month waiting period before any of these services can be rendered.
Member is required to pay an enrollment fee of $_100.00______ to be made on completion of this agreement and subsequent monthly payments of $_______________ to be made on the ________ day of each month thereafter. All monthly payments shall be made via automatic debt from member’s check card or automatic charged credit card. (SFPC uses Paypal services for automatic drafts)
Owner must bring identification and card used to purchase plan.
Member may cancel plan at anytime. Member agrees that if membership is cancelled, Member will pay the difference between the amount paid towards the plan (excluding enrollment fee) and the regular, non-discounted price of all services rendered by SFPC up to the date of cancellation. Member agrees that any amounts due upon cancellation may be debited or charged to Member’s checking, saving or credit card used for regular monthly fees or such account that is on file with SFPC. This Agreement shall be immediately terminated if Member fails to comply with the terms herein or if Member fails to pay monthly fees which are more than 30 days past due.
Pets Name: ____________________________ Age: ___________ Sex: ____________
Member Name: _____________________________________
Member signature: _______________________________
SFPC staff name: ________________
**Please fill out agreement and return to SFPC with Identification and card used to purchase plan.