Client Application

Required fields are marked (*)
  • Welcome to our Hospital! We look forward to serving you and your pets. We’ll be happy to answer any questions you have about your pet’s health. To ensure the best care possible, please take the time to fill in this form completely.
  • Our goal, as always, is to help your “best friend” live a long, happy and healthy life.
  • OWNER INFORMATION

  • Date Format: MM slash DD slash YYYY
  • SPOUSE/SIGNIFICANT OTHER INFORMATION

  • Date Format: MM slash DD slash YYYY
  • If someone, other than those listed above, shares responsibility for your pet’s care, please complete the following:
  • IF WE ARE UNABLE TO CONTACT YOU IN THE CASE OF AN EMERGENCY, WHO SHOULD WE CALL?
  • Date Format: MM slash DD slash YYYY
  • We are happy to provide an estimate before treatment begins. However, estimated costs are subject to change based on the needs of your pet and/or the care deemed necessary by our staff.We reserve the right to refuse or terminate service to anyone for any reason not prohibited by law.ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.For your convenience, we accept Cash, Check, Debit, Visa, MasterCard, Discover, American Express and CareCredit®*. * Applying for CareCredit® only takes a few minutes and there is no fee to apply.
  • PAYMENT OPTIONS

  • Our mission is to deliver the finest, most cost-effective health care treatment available today. We want to ensure that you are getting the best value and strive to set our fees accordingly. Following your pet’s diagnosis, your veterinarian will advise you of the plan for treatment and provide you with an estimate for the cost of services. Feel free to discuss fees before services are performed.
  • Prior to treatment, a deposit may be required.
  • ALL ACCOUNTS ARE TO BE PAID IN FULL AT THE TIME OF TREATMENT.
  • We are sensitive to the fact that some pet owners may not be able to pay cash for their pet’s treatments; therefore, we offer several alternatives for your convenience:
  • * CASH * CHECKS: Local checks written for the full amount due, with the date of service, file name as well as check writer’s name and signature, valid ID and phone number. * CREDIT CARDS: Debit/VISA/MasterCard/Discover/American Express * CARECREDIT®: This is a separate line of credit which does not affect the balances of your other credit cards. Unlike other credit cards, there are no annual fees. Promotional 6-Month Same As Cash is available under the CareCredit® Plan. Ask our front office staff for an application form.
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.