RTVC Concierge Practice Membership

Patient Enrollment Form

Memberships are now required for any service to be provided by The Royal Treatment Veterinary Center (RTVC)

The Royal Treatment Veterinarians and staff will provide comprehensive and advanced integrative veterinary health services and support for our client members and their pets.

RTVC Extended Wellness Concierge, Standard Wellness Concierge, and Modality Only Membership periods are one year from the date of payment.

Fees for Extended Wellness Concierge memberships are to be paid annually or monthly and in advance of the service year or on the first day of each month for the term of one year. As used in this Agreement, the term “Service Year” refers to the 1-year period beginning on the date of payment as well as every 1-year period after that, or first day of each month.

RTVC Extended Wellness Concierge Membership:

Our Extended Wellness Concierge Membership, previously called our Full or Signature Concierge Membership, includes an annual exam, discounted service and prices, as well as access to memberships in affiliate programs and other RTVC resources.
This membership offers excellent value for those clients who are frequent visitors to RTVC, whose animals have more significant care needs, or who wish to meaningfully invest in our brand of veterinary medicine. We are able to accept payment for this membership on a yearly or monthly basis.

Cost: $2,000 annually* or $185/month (monthly payments include a processing fee)

• Annual exam appointment free of charge for one pet per membership
• Longer appointments
• A fully individualized, integrative wellness plan
• Expanded same-day/next-day appointment availability 
• Preferential access to your veterinarian of choice
• No charge for email/text questions/answers unless Telemed phone consult is requested by Doctor
• Full access to triaged urgent consultation and urgent/emergency medical services during business hours, with
  member pricing
• 10% Discount on services, e.g. exams, acupuncture, chiropractic, laser, massage, physical rehabilitation treatments, etc.
• 10% Discount on products, e.g. vaccines and selected medications 
• Additional hours of access to triaged consultation with member pricing – one hour before and after appointments,
  three hours on weekends, and additional specifics TBD 
• Free/Discounted membership in affiliate programs: College of Integrative Veterinary Therapies (CIVT) and
  Animal Diet Formulator (ADF)
• Free/Discounts on various products, testing, and services with future affiliate providers
• RTVC Resources: Newsletter, in house webinars, events, and our Essential Pocket Guides on vet subjects

*Multi-pet families enjoy significantly reduced Signature Concierge Membership and discounts for additional pets

RTVC Standard Wellness Concierge Membership:

Our Standard Wellness Concierge Membership, previously called our Basic Concierge Membership, we feel is an option that will serve those who are more infrequent visitors to RTVC, those whose animals have relatively lower care needs, and those who simply cannot justify the expenditure of the Extended Wellness Concierge Membership. 

Cost: $300 annually per family

• Access to all RTVC services, medicines and products
• Regular prices for services and products
• Access as available to triaged emergency consultation & emergency medical services during business hours, with regular pricing
  

RTVC Modality Only Membership:

For those interested in only specific treatments/treatment packages like acupuncture, chiropractic, and
rehabilitation services that will be offered in limited quantities. Please fill out the enrollment form here. 

Cost: $250 annually per pet

• Initial veterinary modality assessment and plan free of charge
  

Should other medical issues arise please address with your primary veterinarian. If you would like us to address other medical issues, Extended Wellness Concierge or Standard Wellness Concierge Membership, based on availability, can be purchased. Within the first two months, the cost of the Modality Membership may be transferable towards the cost of the Extended Wellness Concierge or Standard Wellness Concierge Membership fees.

Clients are responsible for additional fees for any services, treatments, products, etc. not included in Memberships. Estimates can always be requested prior to service.

All fees for services and products are due at the time of service.

Client fees for services and products will be charged to CC on file, unless other arrangements are made at the time of service.

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Primary Member *

First

Last

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Email *

Email

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Co-family member

First

Last

Optional

Layout

Email

Phone

Other authorized human (authorized agent)

First

Last

Optional

Layout

Email

Other human's (agent's) relationship to pet

Phone

Our Primary Veterinarians at RTVC *

• Dr. Barbara Royal
• Dr. Tricia Stimac
• Dr. Bethany Meno

Pet Enrollment Information

I Received a Needs Based Membership Award

• Yes
• No

Membership Level *

• Extended Wellness Concierge Membership
• Standard Wellness Concierge Membership
• Modality Only Membership

Extended Wellness Concierge Membership *Annual Payment – $300.00Split Payment (2 months) – $166.50

Annual or Monthly Enrollment *

• Annual
• Monthly

Number of Pets to Enroll – Modality OnlyOne (1) – $250.00Two (2) – $500.00Three (3) – $750.00Four (4) – $1,000.00

Select the total number of pets you would like to enroll. Please speak with an administrator for rates if you have more than 4 pets.

Extended Wellness: Number of Pets to Enroll – AnnualOne (1) – $2,000.00Two (2) – $2,200.00Three (3) – $2,375.00Four (4) – $2,525.00

Select the total number of pets you would like to enroll. Please speak with an administrator for rates if you have more than 4 pets.

Extended Wellness: Number of Pets to Enroll – MonthlyOne (1) – $185.00Two (2) – $201.67Three (3) – $216.25Four (4) – $228.75

Select the total number of pets you would like to enroll. Please speak with an administrator for rates if you have more than 4 pets.

Primary/1st Pet Name *

Canine or Feline *

• Canine
• Feline

Date of Birth *

Breed *

2nd Pet Name *

Canine or Feline *

• Canine
• Feline

Date of Birth *

Breed *

3rd Pet Name *

Canine or Feline *

• Canine
• Feline

Date of Birth *

Breed *

4th Pet Name *

Canine or Feline *

• Canine
• Feline

Date of Birth *

Breed *

I have read and understand this Agreement provided to me by The Royal Treatment Veterinary Center. I understand that this Agreement can be terminated upon 30 days’ written notice prior to March 30th 2024. After that all annual memberships will be honored and binding. I understand that after March 30, 2024, if I terminate membership within the year, refunds will not be automatic. Conditions and any Refunds will be individually determined using RTVC guidelines. These guidelines include but are not limited to membership interval, services provided, consultations used, products, discounts/intellectual property/benefits received, client communication and compliance and other factors. Typically, once a comprehensive wellness evaluation, testing and plan have been completed, no refund will be offered.

I understand that the Royal Treatment Veterinary Center reserves the right to terminate subscriptions for clients based on our codes of conduct (zero tolerance for abusive behavior to staff), non-payment and for

Membership positions are limited, and once terminated, a client will lose their priority status to return to the practice and may have to be put on a waiting list if they wish to rejoin the practice.

This Agreement for continued subsequent service is renewable by paying the annual fee for the applicable Service Year as determined by The Royal Treatment. The terms of this Agreement will apply to all such subsequent Service Years, unless The Royal Treatment and client agree otherwise, in writing.

Automatic annual renewal notices will be emailed to each member prior to charging for renewal.

Once you have enrolled, additional benefit information about our Concierge Practice as it evolves will be available to you.

Signature *

Clear Signature

Total

Order Summary

Item	Quantity	Total
There are no products selected.
Extended Wellness Concierge Membership – Annual Payment	1	$300.00
Extended Wellness Concierge Membership – Split Payment (2 months)	1	$166.50
Number of Pets to Enroll – Modality Only – One (1)	1	$250.00
Number of Pets to Enroll – Modality Only – Two (2)	1	$500.00
Number of Pets to Enroll – Modality Only – Three (3)	1	$750.00
Number of Pets to Enroll – Modality Only – Four (4)	1	$1,000.00
Extended Wellness: Number of Pets to Enroll – Annual – One (1)	1	$2,000.00
Extended Wellness: Number of Pets to Enroll – Annual – Two (2)	1	$2,200.00
Extended Wellness: Number of Pets to Enroll – Annual – Three (3)	1	$2,375.00
Extended Wellness: Number of Pets to Enroll – Annual – Four (4)	1	$2,525.00
Extended Wellness: Number of Pets to Enroll – Monthly – One (1)	1	$185.00
Extended Wellness: Number of Pets to Enroll – Monthly – Two (2)	1	$201.67
Extended Wellness: Number of Pets to Enroll – Monthly – Three (3)	1	$216.25
Extended Wellness: Number of Pets to Enroll – Monthly – Four (4)	1	$228.75
Total		$2,735.00

$0.00

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