New Owner & Pet registration

New Owner & Pet registration
Name*

First NameLast Name
Spouse Name

First NameLast Name
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Your Date of Birth*
How did you hear about us
Pets Name*
Gender
Species
Breed
Color
Date of Birth

MonthDayYear
Date
Is your pet microchipped?
{At Best Friends Animal Hospital your pet’s health and well being, as well as your satisfaction as an informed, valued pet owner, is our primary goal. We will gladly provide a written estimate of charges for you -- please don’t hesitate to ask. To prevent the spread of infectious disease, all hospitalized patients must be current on all vaccines and free from internal and external parasites found during the time of hospitalization and will be treated as necessary at the owner’s expense.

I understand and agree to the fact that it is the policy of this animal hospital to receive payment as services are rendered and that a deposit will be required upon admission to the hospital for treatment.

By submitting this form you agree to the terms stated above.}
Signature*

Clear

(Initials) If you need to change or cancel your appointment please call 24-48 hours in advance. If you arrive 10 minutes or more late for your exam you will be asked to reschedule. If you paid a deposit for that exam it will be forfeited. If you reschedule 24-48 hours in advance we will use your deposit towards your next exam.
{Hospital Payment Policy

Payment in full is due at time of service.

For your convenience, we accept cash, personal checks, money orders, Visa, MasterCard, Discover, American Express ScratchPay and Care Credit. There is a $30.00 fee for any returned check.

A 50% deposit of the estimate amount may be required prior to a procedure being performed.

You will be charged the price of an office visit at the time of booking your pets exam. This office visit is only refundable if you have called to reschedule your exam 24 hours prior to your scheduled exam time. If you fail to reschedule your exam your deposit will be forfeited.

Credit lines are available via Care Credit or ScratchPay. Those seeking credit will be asked to apply.

Additional fees are charged for emergencies during office hours and emergencies after office hours.

All balances are subject to a $4.00 minimum monthly billing fee, as well as service charges applied to all accounts unpaid after 30 days and are computed by a periodic rate if 2% per month, which is an annual percentage rate of 30%.

All balances unpaid after 60 days are sent to collection with additional penalty fees. At that time, Best Friends Animal Hospital will no longer be able to provide services for your pet(s).

I have read and understand the information provided to me regarding the payment policy at Best Friends Animal Hospital}
Signature
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