Concierge Service Application Form

Name *

First Name

Last Name

Phone

(###)

###

####

Do you understand and agree to the following: *

Check all to qualify for the program

This program includes (IF RECOMMENDED) up to two visits a year, all needed vaccinations (or titers if possible), yearly bloodwork (2x a year for pets aged 7 or older), yearly urinalysis, blood pressure, unlimited telemedicine, yearly flea/tick/heartworm prevention (Revolution Plus for cats, Nexgard Plus for dogs), and cat nail trims.

Only vaccine certificates will be dispensed, no Rabies tags.

Revolution Plus and NexGard Plus will be dispensed in person during a scheduled appointment - NOT an online pharmacy. Other prescriptions will be addressed on a case-by-case basis.

Visits will primarily be scheduled on Saturdays.

This program does not include sick visits. Mild sick visits will be an additional charge with a 10% discount. Most sick visits will be referred to a full service clinic.

This program is $100/month for the first animal, and $90/month for each additional animal. Payments will be auto-drafted from a saved payment method.

There is a $100 one-time enrollment fee for this program.

Communication with Dr. Long will primarily be via email, with Zoom meetings also available. There will not be phone communication.

Telemedicine appointments will be addressed the same day, unless submitted after 1pm.

Dr. Long does travel throughout the year, and may not be immediately available at all times (unlikely but possible)

This service does include end-of-life services.

This service includes a 10% discount on any additional visits/services/products that are not included.

Clients can un-enroll any time by emailing a request to Dr. Long.