Pet Wellness Clinics

Annual Protection Plan

Client Information

First Name:  
Last Name:  

Patient Information

Pet Name:  

Plan Information

Payment Information

Credit Card Number:  
Expiration Date:  

I understand that I will be billed for the signupfee and first month’s payment today when I check out. I approve my credit card to be billed monthly for the additional 11 monthly payments. I understand thatI will be sent home with no more than 6 months of preventative at any given time, thateach plan is a 12 month, non-cancellable policy, that fees are non-refundable, and that prescription preventatives are unable to be returned. Bridgeview Animal Hospital& Pet Wellness Clinics arenot responsible for overdraft fees associated with myplan. If my payment is not made within 5days of my normally scheduled payment date, my plan will be terminated and I will be responsible for paying for the unpaid product.Unpaid product is determined by invoicing product at regular cost and applying credit for the plan’s monthly payments that have been made (credit of monthly payments does not include sign up fee)I understand that if my pet has a lapse in heartworm prevention for more than 30 days, I am responsible for updating my pet’s heartworm test at my cost, prior to receiving additional preventatives.


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Pet Wellness Clinics
Signature Certificate
Document name: Annual Protection Plan
Unique Document ID: 46a4fa940d9d34a91d2837d08e4b95343f0aedd7
Timestamp Audit
February 7, 2019 9:38 pm EDTAnnual Protection Plan Uploaded by Elizabeth Smart - IP
February 27, 2019 3:47 pm EDTPet Wellness Clinics - added by Elizabeth Smart - as a CC'd Recipient Ip: