PAYMENT POLICY

PAYMENT POLICY
EASTSIDE ANIMAL MEDICAL CENTER
1835 Grayson Highway, Grayson GA 30017 phone: 678-985-5530 fax: 678-985-2730

Please be advised that all patients will be charged an emergency exam fee of $105.00 to $115.00, depending on your regular veterinarian’s membership status with our emergency center. An estimate of diagnostic and treatment charges will be given after the doctor examines your pet.
PAYMENT IS DUE WHEN SERVICES ARE RENDERED
We accept cash, Visa, MasterCard, Discover, and Care Credit. We do not accept checks or American Express.

If you have any concerns regarding paying for your pet’s visit, please inform our staff so we can discuss the best option for you.

Balance may change after auditing record. We will contact you if any changes occur.
Balance may change after auditing record. We will contact you if any changes occur. (please initial)
Please accept our apology if our payment policy seems strict or inconvenient. These policies will allow our focus to remain on your pet’s health. Thank you in advance for your cooperation.

A deposit is required for patients admitted to the hospital.

How do you plan on paying for your visit today? Cash Visa MC Discover CareCredit (please circle)

The card holder must be present. If the card holder is not available in person, please inform our staff as soon as possible.

Print clearly the owner’s or agent’s name - (PERSON RESPONSIBLE FOR PAYMENT)
Print clearly the owner's or agent's name
Current address:
Phone Number:
Alternate Number: (more than one contact number must be listed.)
Name of Pet
Date

Month Day Year
Date
How did you hear about us:
Payment Type:

CASH VISA MC Discover CareCredit
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PAYMENT POLICY

EASTSIDE ANIMAL MEDICAL CENTER

PAYMENT IS DUE WHEN SERVICES ARE RENDERED