New Patient Intake Form

Our Hospital strives to provide your pet with the best health care possible. We make every effort to keep you
informed of costs involved with treating your pet but if you have financial concerns, please be sure to ask for a
treatment plan prior to treatments. I understand that payment is due at time of service. We accept payment
by Cash, Check, Visa, Mastercard, Discover and Care Credit. Any unpaid balances will accrue interest at 1.5%
per month. If the entire balance with accrued interest is not paid within 90 days, reasonable collection fees of
40% will be added to the account and turned over to collections.