By signing below, you agree to the following conditions:
- You assume financial responsibility for all charges associated with the veterinary services rendered to your animal(s) by Ocala Equine Hospital, P.A. Payments may be made in cash, by check or by credit card (Discover, VISA, MasterCard or American Express
- All charges for veterinary services are due and payable within 30 days of statement date; for any amounts unpaid after 30 days, a one and one-half percent (1.5 %) per month (18 % per annum) service charge will be added.
- For services provided in our hospital, payment in full must be received at the time the animal leaves the hospital unless prior arrangements have been made.
- We do not bill insurance companies directly. It is your responsibility to notify the insurance company of a claim and to pay our account charges within our normal credit terms. We will file the necessary paperwork required by the insurance company and the insurance company will reimburse you for covered charges. We only bill insurance companies for insurance exams that have been requested by them.
- We will discontinue providing veterinary services for any account that is 60 days past due.
- Should your account be referred for collection, you agree to pay all the costs and expenses of collection, including, but not limited to, attorney fees and other costs of litigation.
- Because of the high costs of handling NSF checks, a $28.00 charge will be applied to a client's account EACH TIME a check is returned by our bank due to insufficient funds.
I do hereby authorize Ocala Equine Hospital, P.A. to bill my credit card (s) for unpaid sums remaining on my account 60 days after the invoice date.
Signature of owner/ responsible party: