Appetite
Vomiting
Stools
Coughing
Breathing
Urination
Energy
Weight
Has your pet ever had a reaction to a medication (injection, suspension, or pill)?
Medication Name Strength (mg) Dosage (e.g. 1 tab twice daily) Time medication was last given

We need to be able to reach you IMMEDIATELY for questions regarding your pet's anesthetic procedure today, and in the case of an emergency. Please provide the name(s) and phone number(s) that either you or another individual able to make decisions on your behalf for today can be reached.

FINANCIAL ACKNOWLEDGEMENTS

Please be advised that payment is due at the time of services rendered. We do not accept checks from new clients. New clients are to pay by cash and/or debit and credit card only. We do not offer payment plans or extent credit. I agree to pay a deposit of 100% of the outstanding charges and/or estimated fees, as discussed verbally or written by the veterinarian or hospital staff. I agree to assume financial responsibility for the remaining fees and will provide payment via cash, credit card, check, or Care Credit at the time my pet is discharged from the hospital. In the event it should become necessary to place any unpaid balance due for services rendered to me for collection, I agree to pay interest at the rate of 10% per month, or every 30 days.

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