Patient Information:

Date of Last Vaccinations (for dogs):

Date of Last Vaccinations (for cats):

Payment Terms:

Payment is due at the time services are rendered. Past due accounts are subject to a $5 monthly statement fee and a 1.5% interest monthly charge. Delinquent accounts that are past due over 90 days will be sent to collections. In the event of collection, all reasonable collection fees, attorney fees and court costs will be paid by the client. We accept cash, credit and debit cards. We also offer payment plans in the form of Care Credit - subject to approval.

I verify that all information provided above is accurate and that I agree to the payment terms above: