Phone: (678) 208-2200 Email:[email protected]

Forms

Forms

REGISTRATION FORM

At Steeplechase Veterinary Hospital, we use electronic medical records so that we can effectively and efficiently provide the service you deserve!  We recommend that new clients use our registration form, which can be filled out online prior to your visit, and then send it to us by hitting the  “submit” button.  In addition, we encourage you to transmit your pet’s recent Veterinary records, or have your previous veterinarian fax the records to us at (678)208-2201.  Alternatively, you can provide us with the contact information and we will retrieve them for you.

On line registration form

BOARDING DROP-OFF AND CONSENT FORM

Traveling can be hectic. Therefore, if you wish to complete our Boarding Drop-off form in advance, Click Here, and then you can fill it out and either print it and bring it with you to the hospital or  email it to us.   If you are a new client, we request that you also complete a New Client Registration Form so we may serve you better.

RECURRING PAYMENT PLAN 

Checking/Savings Account

Our bank will contact your bank to automatically deduct your Wellness Plan payment from your checking or savings account.  This process is very secure – more secure than paper checks or mailed payments

The Recurring Payment Plan will help you in several ways:

  • It’s convenient (saving you time and postage)
  • Your payment is always on time (even if you’re out of town), eliminating late charges
  • It’s easy to sign up.  Fill out the Recurring Payment Plan Form and return it to Steeplechase Veterinary Hospital

Here’s how the Recurring Payment Plan works:

You authorize regularly scheduled charges to your checking/savings account. We will charge you each billing period for the total amount due for that period. Afterwards, we will email a receipt of payment to you and it will appear on your statement.  The agreement must be approved in advance by the practice owner.