PAYMENT IN FULL IS EXPECTED AT TIME OF SERVICE
Professional fees are to be paid at the time services are rendered. There will be a $25.00 fee on all returned checks. Please read carefully.
Signature is required before exam or treatment.
I hereby consent and authorize Demo Veterinary Website, Inc., its doctors and representatives to administer such treatment, diagnostic, surgical, and anesthetic procedures as they deem necessary. None of the above will be held liable or responsible in any manner whatsoever, under any circumstances, for the care, treatment or safekeeping of animals, as it is understood, I assume all risks.
I hereby certify that I have read and fully understand the above authorization for medical and/or surgical treatment. I also agree that no guarantee or assurance has been made as to the results that may be obtained. Furthermore, I assume financial responsibility for all charges incurred to patient, consent to release of medical information, and authorize direct payment to Demo Veterinary Website.
This practice’s financial policy is that payment is due at the time services rendered.