Cardiff Animal Hospital & Wellness Center

CONSENT FOR TREATMENT: I, the owner or authorized agent of the admitted patient, direct the staff of the Cardiff Animal Hospital & Wellness Center to administer such treatments and diagnostic procedures as necessary and understand the possible risks involved. I/We understand that the results cannot be guaranteed and that complications could occur.

Initial here indicating consent for treatment

COST FOR TREATMENT: The treatment plan does not guarantee the total cost of services provided to your pet. The treatment plan is an attempt to predict the course of the patient’s veterinary care and represents a BEST APPROXIMATION of the cost to provide care based on the known condition of your pet at this time. However, the actual cost may vary due to unforeseen procedures or medications that are deemed necessary to achieve the best results of the procedures/treatment or due to changes in your pet’s condition. Our primary concern is providing your pet with the best care. We will strive to keep you informed of any changes which may cause the estimate to be exceeded, but for various reasons, this is not always possible.

Initial here to acknowledge cost of treatment

PAYMENT DUE AT THE TIME OF SERVICE AND FORMS OF PAYMENT: Payment for all services is due at the time services are rendered. At your request, we will gladly discuss the cost of all services and/or prepare a written estimate of costs for all recommended treatment(s) or services.

ACCEPTED FORMS OF PAYMENT: We accept payment in the form of cash, Visa, Mastercard, American Express, and Discover. We DO NOT accept checks.

THIRD PARTY FINANCING: In addition, we also accept third party financing options for our clients via Care Credit and Scratchpay.

SPECIAL CARE CREDIT CONSIDERATIONS: (1) We only accept the 6-month term with Care Credit. (2) Care Credit requires that payment only be made for services as they are rendered, we therefore cannot charge services to your account in advance. (3) The use of Care Credit requires that the card and card holder be present at the time of payment, and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.
As financing options are available, we do not offer any payment plans for our services.

Initial here to indicate agreement to payment due at time of service and forms of payment accepted

I have read and understand the above authorization and consents, and I assume financial responsibility for all charges, regardless of outcome.

First NameLast Name

Client or authorized representative signature

Pet's name

Date

Cardiff Animal Hospital & Wellness Center

Authorization for Care