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New Patient Information

Client / Owner Information
About Your First Pet
Doctor Referral
City and State

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.

By signing I assume responsibility for all the charges incurred in the care of this animal and understand that these charges are to be paid at the time of service or the time of discharge. I understand that a deposit may be required for surgical treatment. I understand that rescheduling more than once consecutively will result in a rescheduling fee. Additionally, I understand that cancellation or rescheduling must be done at least 24 hours prior to scheduled appointment otherwise the following fees will be applied.

  • Missed Regular Appointment: $60
  • Consecutive Rescheduling Fee: $60
  • Missed Tech Appointment Fee: $50
  • Missed Surgery Fee: $150

* fees are subject to change

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