Drop Off Authorization Form 2017-05-22T09:16:58+00:00

Drop Off Authorization

  • What is the best phone number to reach you at today?
  • What is a secondary number in case we cannot reach you?
  • Please check the significant symptoms that apply to your pet.

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  • Has there been a change in any of the following?

  • PAYMENT IS DUE IN FULL AT THE TIME 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 including interest (any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum). Return check fee is $25. I understand that the hospital staff will provide an estimate of current and anticipated charges any time I request one. 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.

    To prevent the spread of infectious disease and parasites all in-patients, out-patients, boarders and grooming pets must be current on all vaccines and be free of parasites. I understand this to be the strict policy of the clinic and authorize the doctors to provide my pet or pets with vaccinations and parasite control as needed.