Thank you for giving us the opportunity to care for your pet(s). To help us provide the best care possible, please take a few moments to complete this form. All your information is confidential.
I, the undersigned, do hereby certify that I am the owner, or assuming full responsibility, financial or otherwise, for the animal(s) being presented to The Animal Hospital of Barrington for treatment and care. I hereby consent and authorize The Animal Hospital of Barrington to receive/examine, prescribe for and treat, the above described patient(s). A deposit is required for all surgical, dental and medical procedures. We do not bill and ALL FEES ARE DUE WHEN SERVICES ARE RENDERED.
We accept cash, personal checks-valid driver's license required (Established clients ONLY. New clients must choose one of the other accepted forms of payment), VISA, Mastercard, American Express, Discover and Care Credit. I understand, by indicating I agree and submitting this registration, that I have read and understand The Animal Hospital of Barrington's payment policies and if I do not pay my balance in full I am responsible for all statement fees, finance charges, and attourney/collections fees.