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For Pet Owners
For Vets
For Rescues
Services
Services
About
About

Request Appointment

Rescue Enrollment Form:
For Rescues

Use this form to register your rescue organization as a client at VVC and activate eligibility for the 15% rescue discount. Have a copy of your 501(c)(3) determination letter ready to upload, along with contacts for billing, medical decisions, and appointment confirmations. Our team will review and reach out to finalize setup.

"*" indicates required fields

LinkedIn

This field is for validation purposes and should be left unchanged.

Rescue Name*

Email Address*

Address*

Address Line 1 Address Line 2 City State ZIP Code

Primary Contact for Rescue

Name*

First Name Last Name

Phone*

Email Address*

Do we have permission to text you?*

Contact for Appointment Confirmations

If a pet’s foster is the point of contact for appointment confirmations, please include their information on the Rescue New Patient Form.

Use Primary Contact Information above

Use Primary Contact Information above

Name*

First Name Last Name

Phone*

Email Address*

Do we have permission to text you?*

Contact for Medical Discussion

Use Primary Contact Information above

Use Primary Contact Information above

Name*

First Name Last Name

Phone*

Email Address*

Do we have permission to text you?*

Contact for Payment

Use Primary Contact Information above

Use Primary Contact Information above

Name*

First Name Last Name

Phone*

Email Address*

Do we have permission to text you?*

If medication is recommended by the VVC doctors, would you prefer to have the medications filled here?

We offer to keep credit cards on file for rescue organizations.*

Please upload any reference files and/or documents below:

Drop files here or

Max. file size: 49 MB.

Financial Agreement*

You agree to pay in full for the above services rendered. You understand the estimate for these services and that you are legally responsible for the full amount of the invoice the day that services are performed. In the event that a check is returned, you will be assessed a Returned-Check Fee of $25.

I have read and agreed to the financial agreement

Late Cancellations / No-Show Policy*

Vet Vision Center operates on a scheduled appointment basis. Failure to be present at the time of a confirmed appointment OR failure to notify us MORE than 24 hours before canceling the appointment will result in a charge of 50% of the examination fee. Please know that we understand certain circumstances will prevent twenty-four hour notice. These will be handled on a case by case basis.

I have read and agreed to the late cancellations / no-show policy

Photographs & Social Media*

We enjoy sharing photos and videos of our patients and their families on social media and occasionally on print materials and advertising outlets for the hospital. However, we will never do so without your consent! Please agree to grant Vet Vision Center, its representatives, and employees the right to take photographs and/or videos of you and/or your pet, and to copyright, use, and publish the same in print and/or electronically.

Yes, we agree to have photographs taken of our pets

No, we do not consent

Text Messaging*

Message rates vary and not all carriers are covered. Standard message and data rates apply. You may update your preference, and cancel your consent, by notifying us at any time or by replying STOP to any text message you receive from us.

Yes, I agree

No, I have opted out of text messaging

No Overnight Care*

I understand that Vet Vision Center does not provide overnight hospitalization and that my pet must be picked up by 5:30 pm each day. Any patient not picked up by 5:30pm will be invoiced an additional $100 for every 15 minute increment of time after 5:30 pm to cover the cost of our employees staying late.

I have read and agreed to the no overnight care policy

Representative completing this form*

Δ

Hours:

Monday – Friday
7:30 AM – 5:30 PM

Address:

1530 Route 179
Lambertville, NJ 08530

Contact:

(609) 418-EYES
hello@vetvisioncenter.vet

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