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Owner's Information

Name
Address
How did you hear of us?

Pet(s)
Name
Species
Breed
Sex
Is your pet neutered / spayed?
Color
Date of Birth
Reason for Visit
Last Vet Visit
 
I hereby authorize the veterinarian to examine, prescribe for or treat, the above described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of visit/release and that a 50% deposit is required for surgical treatment or admittance.
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Method of Payment
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*For payment by check, full address must be printed or written on the check. Unfortunately we cannot accept starter checks. Driver's License Information is needed for the process of the check. All check are processed electronically with authorization of check writer.