Windmiller Equine Client Service Agreement

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Thank you for using Windmiller Equine as your provider of veterinary services. This agreement will govern the veterinary services we provide to you as a Client either directly or as approved by an authorized agent as listed in this Agreement. This Agreement applies to all horses owned or leased by the Client whether or not listed in this agreement and applies to any veterinary services provided by Windmiller Equine, including but not limited to, in-patient or out-patient services, procedures, medications, supplies and farm calls to any and all horses on Client's behalf.

CLIENT INFORMATION
Individual Responsible for Authorizing Care for Named Horse(s). Must be 18 years or older.

* Indicates required field

Name *

First

Last

Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

Cell or Home Phone Number *

Work Phone Number *

Email *

HORSE (Patient) INFORMATION

List Name, Breed, Age, Color, Gender of each Horse *

Barn/Stable Name *

Barn/Stable Address *

Line 1

Line 2

City

State

Zip Code

Country

AGENT/TRAINER INFORMATION (If Applicable)

Agent/Trainer Name *

First

Last

Phone Number *

Agent/Trainer Listed Above: *

May NOT Authorize Care of Any Kind MAY Authorize EMERGENCY CARE Only May Authorize Care of Any Kind, including prescription medications.

PAYMENT POLICY

We accept payment in Cash, Check, Money Order, Debit Cards, Visa, Mastercard, Discover, American Express, Paypal and CareCredit. Returned checks are subject to a $35 fee.

All fees are payable at time of service. If extended payment terms are required, you may wish to consider CareCredit. CareCredit offers on-line instant credit decisions and extended payment terms with no interest charges (if paid within 6 months). You may apply at https://www.carecredit.com/apply prior to service being performed. If for any reason payment is not made at time of service, a 2% billing service charge (minimum of $10) will apply.

If we are not able to provide a complete invoice at time of service, partial payment will be required and we will e-mail an invoice for any remainder due to the e-mail address on file for your account within 2 business days. No billing service charges will apply. Payment for e-mailed invoices is due upon receipt. Client is responsible for insuring that their e-mail address on file is current and active.

If your horse is insured, please understand that we do not bill insurance companies. Payment in full is due at time of service and you should contact your insurance company for reimbursement. Your insurance company will reimburse you directly according to the terms of your insurance policy.

Invoices that are not paid within 30 days of issuance are subject to a 1.5% monthly late fee (minimum charge $5.00). Invoices that are not paid within 90 days may be referred to a collection agency or may result in legal action. Client agrees to be responsible for all late fees as well as collection agency or legal fees we incur to collect unpaid balances.

Initial below to indicate that you have read, understand and agree to the Windmiller Equine payment policy. *

AGREEMENT and SIGNATURE

By typing my name in the signature box below, I authorize Windmiller Equine to provide veterinary services as I or my agent/trainer (if applicable) request from time to time. I acknowledge that I have read, understand and voluntarily agree to be bound by all terms and conditions within this Windmiller Equine Client Service Agreement as a legally enforceable contract with Windmiller Equine.

SIGNATURE *

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Windmiller Equine Client Service Agreement

Windmiller Equine Service Area

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Windmiller Equine Client Service Agreement

Windmiller Equine Service Area

​Contact Us

Appointments, Emergencies & Information:

​Ambulatory Hours:​​

​Emergency Hours:​

Contact Us

Ambulatory Hours:

Emergency Hours: