• Thank you for giving us the opportunity to care for your pet. We are happy to answer any questions you have about your pet's health. To insure the best care possible, please take the time to fill in this form completely. Thank you!
  • Registration

  • Authorization

  • BY SIGNING BELOW I UNDERSTAND AND AGREE TO: AUTHORIZE THE VETERINARIAN(S) TO EXAMINE, PRESCRIBE FOR, AND PROVIDE INITIAL DIAGNOSTICS FOR MY PET. I AM AWARE A DEPOSIT MAY BE REQUIRED PRIOR TO WORK UP. I AM 18 YEARS OLD OR OLDER AND AM ACCEPTING FINANCIAL RESPONSIBILITY FOR THIS PATIENT. I ASSUME FINANCIAL RESPONSIBILITY FOR ALL HOSPITAL CHARGES. I ASSUME RESPONSIBILITY FOR ALL FEES ASSOCIATED WITH THE COLLECTION OF ANY UNPAID BALANCES INCLUDING $25.00 FOR RETURNED CHECKS. THE BALANCE WILL BE PAID IN FULL AT THE TIME OF DISCHARGE. A 1.5% FINANCE FEE WILL BE CHARGED EVERY 30 DAYS TO PAST DUE ACCOUNTS. SHOULD WE HAVE TO FILE SUIT IN ANY COURT OF LAW TO COLLECT THE AMOUNT DUE, I AGREE TO PAY ALL ATTORNEY FEES AND COURT COSTS INCURRED IN ANY COLLECTION EFFORT FOR MY ACCOUNT. I ASSUME RESPONSIBILITY OF A NO SHOW FEE OF $50 IF I DO NOT CANCEL 24 HOURS BEFORE MY APPOINTMENT.
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