New client registration form

Application Progress3 of 3

I/we hereby authorize the veterinarians to examine, prescribe for, or treat my pets (s). I/we assume full responsibility for all charges incurred in the care of this/these animal(s). I/we also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures.

PAYMENT IS DUE IN FULL AT THE TIME THAT SERVICES ARE RENDERED

I understand that if I do not pay this account as agreed, the account is subject to costs of collection, attorney fees, and interest (26% billing and interest per year; approximately 2% monthly). Returned check fee is $35. I understand that the hospital staff will provide an estimate of current and anticipated charges. I am requesting that veterinary care be provided for pets presented by me or my agents. I understand that I am financially responsible for all services provided. I understand that no employee or veterinarian of Adobe Veterinary Center is scheduled in the center after hours. If my pet is hospitalized overnight, I may choose to transfer him/her to a 24 hour veterinary facility.