Payment Policy and Authorization
- I understand that ALL charges are due at the time of service(s).
- I'm aware the initial doctor examination fee is $175.00.
- Animal ER Care, LLC makes every effort to ensure that all charges are entered at the time of discharge. However, if missed items are found, I understand that I am liable for these charges and will pay said charges within 30 days of the billing date.
- I assume all responsibility for charges incurred in the care of this pet and will ask any questions regarding this payment policy before services rendered. I understand that there will be a $25.00 returned check fee assessed to my account on all returned checks.
- I agree, that in the event that my account is turned over to a collection agency or attorney due to non-payment, that I will pay an additional $30.00 as reasonable collection fees plus any collection costs and attorney's fees incurred in connection with the collection of my account.
- I authorize Animal ER Care, LLC to examine, prescribe for, and treat the above pet. I consent to the release of medical information to and from my family veterinarian(s).
- We occasionally take photos and videos and/or blog about our patients. To opt your pet out of this option please complete the last question on this form.
By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.