"*" indicates required fields

Clients must be in agreement with our billing policy, in order to set up an account and prior to confirming an appointment. After submitting this form, please call our office at (434) 951-9225 to provide your credit card information. Once we have billed you for our services, you can expect an invoice to be emailed and your credit card on file processed shortly afterwards. To update your existing account, please include your account number below.

Account Contact Information

Billing Address*
Horse Information
Horse Name
Location Address
(Click the + sign to the right to add more horses)
(Full number will need to be called into the office)
Alternate Payment Methods
If you plan to use an alternate payment method, having a card on file is still required. Please notify the clinic of your alternate payment method preference prior to or directly after your appointment.
Choose Alternate Payment Method
By submitting this form, you agree that all information provided is accurate, and that Old Dominion Equine Associates has the right to charge the account balance due to your provided payment method.
Please enter your full name in the field above. By doing so, you acknowledge that this serves as your digital signature.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.