Choose your Wellness Plan Date* Date Format: MM slash DD slash YYYY Name* First Last Phone*Email* Horse NameWellness Plan Option (Select One)* Silver Wellness Bronze Wellness Add on options (Select all that apply)* CBC/Chemistry Package ACTH/Insulin Package No add on options Method of Payment*We accept all major credit cards, cash, check, Care Credit and Farm Plan. Please call the clinic to with credit card numbersConsent* I agree to the Terms and Conditions Terms and Conditions: Enrollment begins at the receipt of payment prior to first visit. There is no carry over to the following year. Payment and enrollment are required prior to appointment. We accept cash, checks, Farm Plan, Care Credit and all major credit cards for your prepayment convenience. Please be sure to call in advance to schedule your Wellness appointments. There are no refunds or substitutions for any services offered in your selected level which are not utilized within the enrollment term. If an enrolled horse is sold or dies while participating in the Wellness program, a prorated refund will be given or you may transfer the level to another horse (with a limit of one transfer per term). Selected levels may not be changed during enrollment term, but may be changed the following enrollment year. Any discounts offered through the Wellness program can only be applied to the enrolled horse. The following services are excluded from the Wellenss program: Call fees, Initial booster vaccines, additional services not specified. Reminder - to receive the full benefit of your Wellness plan, please collect a fresh fecal sample to provide your veterinarian during your wellness appointment. The sample should be placed in a ziploc bag and should not be more than 24 hours old. If collected the night prior to your appointment, the sample should be refrigerated. Remember to label the ziploc bag with your name, your horse's name and date collected.