In case of emergency...
This form supports telling us about 2 pets in your home. If you have more than 2 pets, please let our office know and we will happily collect information to add them to your account.
I hereby authorize the Veterinarian to examine, prescribe for, and/or treat the above described pet and any others I may bring to the hospital. I assume the responsibility for all charges incurred in the care of the animal.
Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash.
In addition, we also offer several 3rd party financing options for our clients via Care Credit. We accept a variety of Care Credit plans based on the total transaction amount for your pet.
Full payment is due at the time of service. This includes any charges/fees agreed to by my authorized proxy. Our team is happy to provide any client with a written treatment plan prior to services being rendered. Client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.
By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Santa Clara Animal Hospital to examine, prescribe for or treat my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the exception of another veterinary facility.