A Division of Beltway Veterinary Cardiology, Inc. 6700 LaurelBowie Rd; Bowie, MD 20715 Phone: 3018800 Fax: 301
You will be advised of the recommended diagnostic procedures and associated costs. Payment is required at the same time your pet is discharged from the hospital. If your pet requires hospitalization, a minimum payment of 100% of the high end estimated charges is required. By signing below,I authorize Dogs & Cats Vet Referral to charge my credit card used for the deposit for any remaining balance due, if no other form of payment is given.
I am the owner of the above described pet,or, I am acting as an agent and have authorization from the owner to consent to its treatment.
I am at least 18 years of age.(PHOTO ID REQUIRED)
I accept full financial responsibility for these services.
We accept: CASH, VISA, MASTERCARD, DISCOVER, AMEXCARE CREDIT AND CHECK (with ID)
** Please return this form to the front desk when completed! **