This form supports telling us about 4 pets in your home. If you have more than 4 pets, please let our office know and we will happily collect information to add them to your account.
Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash and personal checks. Full payment is due at the time of service.
Our team is happy to provide you with a written treatment plan prior to services being rendered. 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 Village Veterinary Practice 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 the animal(s) listed on this form.