We offer the following methods of payment: Cash / Check / Credit Card / Debit Card

Checks are processed electronically and will be returned as your receipt.

Valid government-issued photo identification must be presented for all clients.

Financial Consent: I understand that full payment must be made for outpatient services at the time the services are performed. The doctor will prepare an estimate after examining my pet and I further understand that the estimate is based upon the initial exam of my pet. The estimate may change as further diagnostic and therapeutic procedures dictate. I understand that this is an estimate and the final charges are based on procedures performed. I assume financial responsibility for all charges incurred and agree to pay 100% of the low end of the estimated cost or 50% of the high end, whichever is greater, at the time of admission. Additional deposits will be required if further care or procedures are needed. I agree to keep 75% of the total bill on deposit at all times. I further agree to pay the balance of all invoices at the time the pet is discharged from the hospital or when services are otherwise terminated. Final fees may vary considerably from the estimate. I understand that every effort will be made to keep me informed of the current status of my bill throughout my pet’s hospitalization.

In the event of nonpayment, I agree to pay interest at the rate of 1.5% per month, which will be added to any outstanding balance. I understand that in some cases not all fees are invoiced at the time of discharge, but I am still responsible for all authorized charges. If this account is referred to an attorney for collection, I agree to pay an attorney’s fee of 33.33% of the balance and all court costs incurred. Should any of my checks be returned for nonpayment, I agree to pay a bank charge of $25.00 per check. If the matter is turned over to collections, I agree that Rhode Island will be the Forum State for all litigations.

I certify that I have read, understand and agree to the above information. I acknowledge that my questions, if any, about the inquiries set forth above have been answered to my satisfaction. I will not hold Bay State Veterinary Emergency and Specialty Services, Ltd., or any other member of its staff responsible for any errors or omissions that I may have made in the completion of this form. I certify that I am at least 18 years old and proof of age can be verified upon request.