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OWNER INFORMATION

Address(Required)
May we leave phone messages (labs, etc)(Required)
Emergency contact should be someone other than the owner(s) of the pet

PET INFORMATION

Species(Required)
Sex(Required)
(food, vaccines or medications)
Do you have a second pet?(Required)
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Second Pet

Species(Required)
Sex(Required)
(food, vaccines or medications)
Please indicate how you found us(Required)

AUTHORIZATION

I authorize the release of information about my pets TO another veterinary hospital or kennel?(Required)
I authorize the acquisition of information about my pet FROM another veterinary hospital or kennel?(Required)
I authorize the use of my pet's name, image, and associated events pertaining to my pet to be used in advertising and social media, such as Facebook, Twitter, and other print or internet mediums.(Required)
I authorize communication about and instruction regarding the care of my pet’s health with friends or family.(Required)
Hospital Policy
Consent(Required)
Appointment attendance is important for my pet’s health and the hospital’s ability to schedule appropriately. I understand that surgeries require 24-hour cancellation notice. After 2 surgical no shows or 3 appointment no shows, I will have to pre-pay for my appointments.
Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
Fees and Expenses Incurred(Required)
East Montgomery County Animal Hospital requires payment in full at the time services are rendered. The Hospital does not bill or accept payment plans. For payment, we accept Mastercard, Visa, Discover, American Express, cash, Care Credit and Scratch Pay.
Hospitalization requires a 50% deposit of estimated or $200, whichever is greater.
An estimate can be provide, upon request. An estimate tries to approximate the expenses of medical care, but may not be 100% accurate. While the hospital will try to keep within the estimate’s range, it is the owner’s responsibility to pay for the actual charges incurred. In the event that you do not pay for services rendered and collection attempts were futile, your outstanding balance will be turned over to the sheriff’s office for “theft-of-services”.
Any outstanding balance on your account will be charged 1.5% interest rate on the last day of each month.

In an emergency

I have read and agree to abide by the above hospital policies. By signing below, I authorize the veterinarians at East Montgomery County Animal Hospital to examine, treat and prescribe for my pets. I agree to be responsible for all charges incurred in the care of this/these animal(s).
Date(Required)