Owner Information

Pet Information

Medical History/Vaccinations:

Please have available a copy of your pet’s records or

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE RENDERED.

For your convenience, we accept cash, Visa, MasterCard, Discover, CareCredit and Debit cards.
We will gladly prepare a written estimate if you desire; please ask the veterinary technician or the doctor.
I understand that by signing this document I authorize medical treatment for my pet(s) and intend to pay for services on the date(s) performed. I assume financial responsibility for all charges incurred for services rendered to the patient(s), including any legal, collection, billing and/or interest fees (currently 1.5% monthly - APR 18%) incurred as a result of my failure to meet this responsibility. For accounts sent to a third party for collection, a fee of up to 35% of the unpaid balance may be added to your account. I also consent to the release of medical information.
I acknowledge and agree to comply with the following cancellation policy: If I do not show up for my pet’s scheduled appointment and I have not notified your office at least 24 hours in advance, I will be required to pay a missed appointment fee of $50.00. The missed appointment fee for any surgical or dental procedure is $125.00 I also consent to the release of my pet’s medical information.