Policy Agreement Form Please complete and submit the required Policy Agreement form prior to your visit. Policy Agreement Form Veterinary Dermatology of New England is one of very few dermatology specialty practices in the New England area. Our goal is to help as many dogs in need that we possibly can. In order to avoid wasted appointment slots, we have implemented the following appointment and cancellation policy: We require a 48-hour notice of cancellation so another patient may be offered the appointment slot. No-show appointments will not be re-booked. As a courtesy, we will contact you to confirm your dog’s appointment. If we are unable to reach you, we will leave a message asking that you contact us to confirm your dog’s scheduled appointment. NOTE: Veterinary Dermatology of New England reserves the right to reschedule your appointment if we do not receive a confirmation at least 24 hours before your appointment time. Due to the high volume of patients in need, we ask that you arrive on time for your scheduled appointment, as late arrivals impact subsequent clients/patients/appointments. NOTE: Veterinary Dermatology of New England reserves the right to refuse service to any client who arrives fifteen minutes late for their scheduled appointment, as this will negatively impact the next scheduled client and patient. We are not presently accepting new feline patients. Important: When scheduling an Initial Visit, or a Recheck Examination, please note that your pet’s primary caregiver MUST attend the appointment.The doctor will speak with you in-depth about exam findings, laboratory testing, laboratory test results, and treatment. You will also be given written instructions. There will be a lot of information covered, and it is vital that the primary caregiver is the person that consults with the doctor about their pet. The doctor is unable to go over this information again after the fact by phone or email. A consultation appointment with the doctor is required if the person attending the appointment is unable to convey all the information/instructions to the primary caregiver. We thank you for your cooperation!Payment PolicyPayment for service is required at the time services are rendered. As a form of payment we accept; Cash, Personal Check, Money Order, Visa, MasterCard, Discover and American Express.Picture PolicyPhotos are taken of your pet for identification and educational purposes. The pictures may be used on our website, journals, papers, lectures or as teaching aids. By signing below, you agree to our use of your pet’s picture.If you do not want your pet’s picture used on our website, in written material or as a teaching aid, please check here. Not Authorized Prescription RefillsPrescription refill requests may be phoned or texted into our office, and medications picked up during our normal business hours. Phone: 978-399-0300. Text: (Idexx Communicator): 978-355-7097. If you are unable to pick up your pet’s medication, we will be happy to ship it to you. Shipping and handling fees start at $10, and will be applied to your invoice. Additional charges may apply, depending on the cost of the medication, insurance, weight and zip code. Payment will be taken by credit card at the time of request. Please do not send any financial information via text. We will be happy to call you back to accept payment over the phone. Note: As most of the medications we prescribe are not available at human pharmacies, we do not provide written prescriptions, and are unable to call medications in to pharmacies.I have read and agree to these policies.* I agree Name* First Last ONLINE FORMS Dermatology History Policy Agreement Veterinarian Referral