• Exam Deposit Form

  • I,      , the owner of the appointed caregiver of   * , described above have the authority to execute this consent.  


    I hereby authorize ABC Veterinary Hospital to collect the deposit in the amount of $70.00. I understand that by signing this form, I agree to the following:
    The deposit collected is to secure and schedule my first exam with ABC Veterinary Hospital.
    The deposit collected will go towards the balance of the appointment.
    Should I need to cancel or reschedule, ABC Veterinary Hospital requires a 24 (twenty-four) hour notice to be given.
    The deposit is fully refundable as long as the 24 (twenty-four) hour notice is provided.
    If less than 24 (twenty-four) hour notice is provided, the entire deposit will be forfeited and will not be refunded.
    I understand and agree to pay the balance in full upon the discharge of my pet.
    The deposit collection and relevant cost have been full explained to me, to my satisfaction.




    I have read, understand and agree to accept the terms and conditions herein.

  •  - -
    Pick a Date
  • Clear
  • Should be Empty: