This form supports telling us about 3 animals in your care. If you have more than 3 animals, please let our office know and we will happily collect information to add them to your account.
Our office accepts e-transfer, Visa and Mastercard. We also accept cash and checks (only with verification of valid drivers license or other ID at time of payment).
Full payment is due at the time of receipt of month end statement. 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.
going forward, in 2021 Clients will be responsible for a 1.5% monthly finance charge on accounts over 90 days and any collection and/or legal fees on accounts over 120 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 Moion Equine Veterinary Services to examine, prescribe for or treat my animal(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.