AUTHORIZATION FOR MEDICAL AND/ OR SURGICAL TREATMENT AND FINANCIAL RESPONSIBILITY
I HEREBY AUTHORIZE Central Carroll Animal Emergency, LLC to examine and treat the animal described below medically and/ or surgically. I understand there is no guarantee of successful treatment. I also consent to the administration of such anesthetics as are necessary and surgical procedures of an emergency nature. I assume complete financial responsibility for any and all charges incurred to patient for such exam and treatment. I further understand that emergency patients must be picked up from this facility by 8:00 am. Through the week we do not offer 24 HR care. Patients admitted Friday, Saturday, Sunday or Monday nights may, if necessary, remain at Central Carroll Animal Emergency until Tuesday at 8:00 am and I will be responsible for related charges, including hospitalization. I hereby agree to pay at the time services are rendered. I understand that Central Carroll Animal Emergency, LLC does not bill for any services or items. I have read and fully understand this authorization for medical and/ or surgical treatment.
I UNDERSTAND THERE IS A $95 EXAM FEE.
We accept the following (with valid Drivers License): Cash Visa MasterCard Discover American Express Checks
*There will be a $35 return check fee for all returned checks*
We CANNOT accept Home Equity Line of Credit Checks or Business Checks.
If money is an issue please ask us about CARE CREDIT or SCRATCHPAY