Intake Check-In

  • Client Information

  • Date Format: MM slash DD slash YYYY
    required for prescription medications
  • Patient Information

  • Payment in full for all charges are required at time of service.

    It is understood that a treatment plan will be presented to me that will include any additional recommended treatments, diagnostics, or procedures and all cost associated with those services. I understand that no guarantee or assurance can be made as to the results that may be obtained. It is thoroughly understood that I assume all risks involved with any treatments or procedures. A deposit of the lower end of the estimated Treatment Plan is required in order to begin treatment of hospitalized patients. Payment in full of the remaining balance must be made when the patient is released. I am 18 years of age and/or over, I understand that I am authorizing care to the animal listed above and responsible for all costs that may be incurred.
  • I have read the above terms and agree to comply.
  • This field is for validation purposes and should be left unchanged.