I have been advised as to the nature of the procedures or operations and the risks involved. I realize that results cannot be guaranteed. I also assume financial responsibility for all charges incurred to the patient, and agree to pay all such charges at the time of release of the patient.
I further understand that In the event of nonpayment, fraudulent payment, bounced checks, or any violation of any prior agreed payment arrangement, the entire balance shall be considered in default with the addition of any and all banking, collection fees, collection agency and/or attorney fees, necessary to the amount due to Highland Veterinary Clinic without any relief whatever from Valuation and Appraisement Laws. I further understand that my check may be presented electronically at any time for validation or deposit.