Adult Total Wellness Form

Save time during your next appointment! Complete your required
form online from any device at any time before your visit.

Adult Total Wellness Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.  Adult pets are 2+ years old.

Enrollment Form

Monthly Fee $65.00
Enrollment Fee $25.00

Total Wellness includes:

-Routine Dental Cleaning Under General Anesthesia
-Two Comprehensive Wellness Exams
-Year-Round Flea Treatment
-Two Exam and Consultations to use Whenever the Need Arises
-All Recommended Annual Vaccinations
-One Deworming Treatment
-One Complete Blood Count and Chemistry -Panel Along with Urinalysis
-Free Simple Nail Trims (limit 6)
-10% off all Other Products and Services

*Total Wellness Program is not insurance
*Pet food is excluded from the 10% discount

Agreement and authorization

By signing below, I acknowledge that I have read and understand the Notes and Terms/Conditions of this agreement as described on this page and the following page, and I agree to them. I understand that this is a one-year contract and will automatically renew unless I cancel. Accordingly, I authorize Grays Harbor Veterinary Services to charge the amount listed above to my credit/debit card on file.

Clear Signature

Notes

  1. This wellness plan IS NOT INSURANCE. We recommend an additional pet insurance policy to cover unexpected accidents and illnesses. This plan covers the routine wellness services as recommended by the American Animal Hospital Association.
  2. 'entire series of vaccinations' means Rabies, DAPPV, Bordetella, and Leptospirosis as needed/recommended by the doctor for dogs and Rabies, HCP, and Feline Leukemia as needed/recommended for cats. Any extra treatments for pets that are known to have a vaccine reaction or who experience a vaccine reaction will be separately and additionally charged. These charges are due and payable at discharge.
  3. Spay or Neuter Procedure consists of a pre-surgical exam, pre-anesthetic blood/urine screening, anesthesia, monitoring, IV catheter and fluids, and the routine surgical procedure. Additional charges may apply for pets that are in-heat, pregnant, or obese. Should your pet have any form of infection the procedure may be delayed, and the cost of treatment will be separately and additionally charged. These charges are due and payable at discharge
  4. Savings calculation is based on a hypothetical pet receiving all included services plus additional services/products (priced at $293 per year for dogs and $240 per year for cats; data from APPA National Pet Owner's Survey 2009-2010). Exact savings will vary because some charges depend on weight and because some pets require more veterinary services than others.
  5. If dissatisfied, you may cancel your membership at any time and apply monthly fees paid towards the regular, undiscounted cost of products and services received (see below). This is the full extent of the guarantee and your sole recourse if dissatisfied. Treatment outcomes or service levels are not guaranteed.

The enrollment fee is not refundable.

  1. Doctor examinations are to be in person and by appointment only. You must bring your pet with you. All three of these conditions must be satisfied, otherwise, you will be separately and additionally charged.

Terms and Conditions

The Client named above, with whom this agreement is made, has purchased from Grays Harbor Veterinary Services ("Provider") a Wellness Plan ("Plan") to the pet identified above ("Pet"). The Plan consists of discounted veterinary services, as specified above. The Client agrees to pay the Provider the initial non-refundable membership fee (may be waived if Client is in possession of a valid coupon) and the monthly installments specified above for the full 12-month term of this agreement for cats and 18-month term of this agreement for dogs, subject to the cancellation terms listed below.

  1. General. This agreement and the services provided under it are not transferrable to another pet, may not be shared between pets, may only be used for the Pet specified on the previous page, and may only be redeemed at Grays Harbor Veterinary Services. Total Wellness is not insurance.
  2. Eligibility. Participation in Total Wellness Puppy/Kitten is open to all pets under 9 months. The client must be on current terms with the Provider and have no outstanding balance due.
  3. Duration and renewal. This agreement is effective on the Start Date shown on the previous page for an initial term of 12 months (Plan Year) and will automatically renew to the adult Total Wellness Program on the anniversary of the Start Date in each successive year for subsequent periods of one year until canceled by Member or Provider as described below.
  4. Plan Contents. Only the services listed on the previous page are included. Any services not listed are not included. Unused services do not carry over to subsequent years and are considered 'lost' unless used within one year of the date of the agreement. Plan contents refresh upon renewal.
  5. Service level. Member agrees that appointment availability remains on a 'first come, first serve' basis. Although the Provider will make a reasonable effort to accommodate the Member, The Plan does not include a guarantee that the Member will get his or her first choice of appointment time.
  6. Appointment Cancellations. Provider reserves the right to charge a missed appointment fee equal to the amount of a doctor visit (currently $49) if any scheduled appointment is missed or canceled less than 24 hours prior to the date/time of that appointment.
  7. Fees. Fees charged for products and services not included in the Plan will be determined in accordance with the fee schedule in force at the time those products are sold and those services are rendered and must be paid in full at that time.
  8. Discounts. The 10% discount applies to all Providers' products and services that are not included in the Plan, with the exception of pet food.
  9. Payment. Monthly installments shall be billed directly to the Member's credit or debit card. Member is responsible for immediately notifying Provider of any change in the billing information. Member is responsible for any payment processing fees incurred as a result of changes to billing information not disclosed to Provider.
  10. Cancellation. Either Provider or Member may cancel this agreement at any time, but monies may be due to either party upon cancellation. The amount of any monies due is calculated by comparing the regular, non - discounted cost of all products and services received by Member, as they are priced on the date of cancellation, with the total fees paid by Member (less any enrollment fee paid), since the effective date of this agreement or the effective renewal date- whichever is the more recent. If this agreement is canceled having been automatically renewed as described above, then any and all monies paid in previous terms of the agreement shall not be considered when calculating the fees due. Only monies paid in the current term of the agreement shall be considered.
  • a. If the total monthly monies paid is less than the total regular, undiscounted cost of all products and services received, then Member shall owe Provider the difference. Payment is due on the date of cancellation and will be charged to the account on file.
  • b. If the total monthly monies paid is greater than the total regular, undiscounted cost of all products and services received, then Provider shall owe Member the difference. Payment will be made by check, mailed to Member's address of record, within 10 business days of the date of cancellation.
  • c. The enrollment fee, if paid, is not refundable.
  1. Pet Death. In the event of pet death, this agreement will terminate, and no additional fees will be owed by either Member or Provider
  2. Transfer of pet ownership. If the ownership of a participating pet is transferred, this Agreement shall be deemed canceled as of the date of transfer, and the procedure described in 'cancellation' followed.
  3. Price Changes. The monthly price of the Plan, as specified on the previous page, will be the price charged for the duration of the 12 or 18-month term. Provider reserves the right to change the monthly price of the Plan effective the date of renewal and notify Member of that change at least 10 business days prior to that date. All other prices are subject to change at any time without notice.
  4. Service changes. The provider undertakes to notify Member of any changes to services included in the Plan when it renews, at least 5 business days prior to that date.
  5. Exclusions. Pet food is not included in this Agreement.
  6. Default. If Member fails to pay any monthly installments within 5 business days of the due date, Provider has the option to immediately cancel this agreement according to the procedure above and bill Member for any monies owed.