Veterinary Services Contract

Veterinary Services Contract

Please note: By submitting this document, you are forming a contract with PIEDMONT EQUINE PRACTICE. This contract creates certain rights and obligations including, but not limited to, those described in this contract.

Payment is required at the time of service unless prior arrangements have been made. A credit card on file is required for all clients who wish to be billed monthly. Insurance claim payments for major medical claim will be sent to you directly from your insurance company.
  • Client Information

  • Emergency Contact

  • Patient Information

  • Barn Manager/Trainer

  • I authorize the Piedment Equine Practice to provide routine care to my animal(s) in my absence or at my barn management's request.

    In the event of an emergency and I, the owner, can not be reached I authorize The Piedmont Equine Practice to provide emergency care to my animal.

    I understand that any invoices incurred are my responsibility to pay and should be paid in full within 30 days of receiving my invoices.

    I understand that any past due invoices will be subject to interest charges of 18% per annum that I am resposible to pay.

    I represent that I am presently able to comply with the payment terms herein, and that if I should become unable to make timely payment of outstanding invoices, I will contact the Piedmont Equine Practice to set up a payment plan.

    Should The Piedmont Equine Practice be forced to commence administrative or legal action to collect unpaid invoices:

    1. I consent to personal jurisdiction of The Circuit Court of Fauquier County,

    2.I agree to pay all costs and reasonable attorney's fees incurred by The Piedmont Equine Practice that are associated with such action.

Contact Us

4122 Zulla Road
The Plains, VA 20198

Phone: 540-364-4950
Fax: 540-364-4987

Phone: 540-364-4954

Office Hours of Operation
Monday8:00am – 5:00pm
Tuesday8:00am – 5:00pm
Wednesday8:00am – 5:00pm
Thursday8:00am – 5:00pm
Friday8:00am – 5:00pm

We are on call 24/7 for emergencies.