Owner Information
Pet Information
Medical History/Vaccinations:
Please have available a copy of your pet’s records or
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.