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.
Please contact your previous hospital/clinic and request that your medical records be emailed to firstname.lastname@example.org. Once we recieve the records, they will be reviewed by one of our veterinarians. When the review is complete, we will contact you to schedule your pet's visit with us.
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.