New Patient Form

Financial Policy

I understand that I am financially responsible for my pet's medical services and that payment is due at the time of service. Forms of payment accepted are as follows:

• Cash
• Credit
• Debit card
• Check (must have ID present and a fee of $25.00 is charged on all returned checks)
• Venmo

There are payment plan options available through CareCredit and Vet Billing. Let us know if you would like more information.

For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance company.

I hereby authorize the veterinarian to examine, prescribe for, and/or treat my pet(s). I assume full responsibility for all charges incurred for the care of all pets listed on my account. I also understand that payment is due at the time of service and that a deposit may be required for surgical treatment or hospitalization.

Canyon View Cares - Perry charges 1.75% interest per month (21% per year) with a minimum charge of $3.00 on all outstanding account balances older than 30 days, including returned check balances. If you have an account 30 days past due, Canyon View Cares - Perry may relinquish your balance owed to an outside collection agency. Any balance referred to an outside collection agency will incur a collection fee of 40%, and you will be responsible for all court costs and attorney fees associated with collecting your balance.

All product sales are final, including but not limited to pet foods, controlled substances, prescription drugs, and over-the-counter products. In some cases where a manufacturer guarantees the product, a return may be possible. We reserve the right to charge a 10% restocking fee on all returned products, and all returns must be approved by the practice manager and the attending veterinarian.

Extra-Label Drug Use

The FDA oversees the licensing of pharmaceuticals for humans and animals. Many drugs that have been approved for use in humans and/or some animals have also been proven to be safe and effective in species for which the drugs are not labeled. Drugs are considered to be used in an “extra-label” manner when an FDA-approved drug is used to treat a different species that it was approved for.

Extra-label use does not include the use of experimental drugs and drugs manufactured in foreign countries that have been approved by the FDA. Despite this lack of FDA approval, it may be necessary to occasionally use such drugs when no other effective options exist.

All drugs can potentially cause harmful side effects, including death. The drugs that will be used for your pet at Canyon View Cares - Perry have been safely used in individuals of the same or related species. When a drug must be used to treat an unusual disease or an unusual species, effectiveness and safety can be difficult to predict. You will be advised when your pet has been prescribed a medication that has not been given to a significant number of individuals of a similar species with a similar medical condition.

I authorize the staff at Canyon View Cares - Perry to administer and prescribe extra-label drugs for my pet. I understand that any drug, including those that are used in an extra-label manner, can produce undesirable side effects. Thus, I acknowledge that it is my responsibility to administer the prescribed medications for my pet as directed and to notify my veterinarian of any apparent side effects of complications.

Medical Record Confidentiality

Your personal information and pets' medical records are completely confidential and protected by law. According to Utah’s Veterinarian-client-patient confidentiality, Canyon View Cares - Perry may not disclose information on our care of an animal to anyone other than the client, as defined in Section 58-28-102, unless:

• The client consents to the disclosure in writing;
• Disclosure to public health officials, animal health or welfare officials, agricultural authorities, or federal, state, or local officials is required, or necessary to protect the animal or to protect public health;
• Disclosure is required by court order or subpoena; or
• The client has placed the veterinarian’s care or treatment of the animal or the nature or extent of injuries to the animal at issue in a civil or criminal proceeding.

Canyon View Cares - Perry takes the confidentiality of your personal information and your pets’ medical records very seriously. We do not and cannot release this information without your express written consent. At times, we may share your information with our third-party partners to enhance your veterinary experience. These partners are contracted by us and follow the guidelines we set forth regarding confidentiality of your information. These partners are hired by Canyon View Cares to provide specific client services and will never use your information for their own purposes.

In the case of microchipping your pet, certain personal information and your pet’s name will be released to PetLink to register your pet with their pet recovery database. At times, we may release test results or diagnoses to research organizations to better the veterinary field and treatment regimes, but in no way will identifying or personal information be released.

At times, you may wish for us to release certain medical information to boarding, grooming, and/or other veterinary hospitals. We are happy to provide this information but must have written consent from you to release this information. If you wish to give us written consent to release your pet’s medical records to veterinary hospitals or boarding facilities at our discretion, please select the box below. Otherwise, we would need to get written consent from you each time.