Name: By-pass Animal Clinic
Address: 1401 Lexington Road, Richmond, KY, 40475, US
Telephone: 859-625-1144
Price range: $$

New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

A $25.00 non-refundable deposit is required at the time of booking your first appointment. This deposit is applied to the balance on the day of your appointment. Deposits are only refundable if the appointment is either changed or cancelled at least 48 hours prior to the appointment time.

Please complete this form as fully as possible before your first appointment. This will help expedite the registration process and give us valuable insight into providing optimal care for your pet(s). The required sections have a red * asterisk.

Owner's Name
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Owner Phone #*
Email*
Enter Email Confirm Email
Emergency Contact Information
Name
First Last
Phone
Patient 1
Pet's Name*
Breed (if known)
Date of Birth or Age (if known)
Color
Sex
Patient 2
Pet's Name
Breed (if known)
Date of Birth or Age (if known)
Color
Sex
I, the owner of the pet(s) on my account, give permission to BPAC to use pictures/videos of my pets on BPAC social media platforms.*
- Yes
- No
I am the Owner/Agent of Pet(s) described and all information presented above is correct to the best of my knowledge. I authorize ByPass Animal Clinic & Staff to perform all treatments, procedures and anesthesia that are necessary for my pet(s) listed above and on my account. I understand that I am responsible for my pets health cost and the invoice is to be paid for at the end of treatment before my pets are released from BPAC’s care. I understand that BPAC requires a $50 non-refundable deposit for each scheduled surgery. BPAC uses all reasonable precautions against injury, escape or demise of the animal and will not be held responsible. I understand that my pet must be in a carrier or be leashed properly while on the premises for the safety of my pets as well as the safety of others. BPAC reserves the right to refuse/discontinue services and/or Client/Patient relationships at any time.
I agree
I agree to the above
First Last
Payment
NEW PATIENTS/SURGERY WITH NO EXAM IN THE LAST 12 MONTHS WILL BE CHARGED A EXAM FEE PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED WE DO ACCEPT ALL MAJOR CREDIT CARDS, OR CASH. WE ALSO ACCEPT CARE CREDIT IF YOU WISH TO APPLY. ADDITIONALLY, THERE IS A $25.00- $50.00 SERVICE FEE ON ALL RETURNED CHECKS

Hello! Have a question? Want to make an appointment? Give us a call today!

Request Appointment Get Directions

Contact

Phone: 859-625-1144
bypassanimalclinic1@gmail.com

Address

1401 Lexington Road
Richmond, KY 40475

Hours

Monday: 7:30 am – 7:00 pm
Tuesday: 7:30 am – 5:30 pm
Wednesday: 7:30 am – 5:30 pm
Thursday: 8:00 am – 5:30 pm
Friday: 8:00 am – 5:30 pm
Saturday: 8:30 am – 12:00 pm
Sunday: Closed

New Client Registration Form

Owner's Name

Emergency Contact Information

Patient 1

Patient 2

Payment

Hello! Have a question? Want to make an appointment? Give us a call today!

Contact

Address

Hours