ATTENTION: PLEASE ONLY FILL OUT THIS FORM IF YOU ALREADY HAVE AN APPOINTMENT SCHEDULED AT OUR CLINIC.
Thank you for giving the Point Breeze Veterinary Clinic the opportunity to care for your pet. To ensure the best care possible, please take the time to fill out this form in its entirety.
Pet Health History
I hereby authorize the veterinarian to examine, prescribe for, and otherwise treat the above described pet. I assume responsibility for all charges incurred in the care of this pet. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.
The following forms of payment are accepted: Cash, Checks, Visa, MasterCard, DiscoverCard, American Express, e-Checks