As a condition of treatment by Redwood Veterinary Hospital. I/We, being the Responsible Party, 18 years of age or older, understand that payment is due at the time that medical services are rendered. My signature below forms a binding agreement between Redwood Veterinary Hospital and the Responsible Party who is requesting and receiving Veterinary Services for a patient. I/We understand that all financial arrangements must be made prior to any services being rendered. The Responsible Party is the individual who is financially responsible for payment of all Veterinary Services. All charges for Veterinary Services rendered are due and payable at the time the service is rendered. The Responsible Party agrees to pay interest at the rate of 0.83% per month (10% per year) on any past due balances.
Express Consent to contact via cell phone:
I give my express permission to contact me at all my phone numbers including, but not limited to, my current cell phone or any cell phone number that I may have in the future, for the purposes of communication regarding my account including, but not limited to, obtaining information to keep my account current and to collect a debt that I may owe. This permission shall also transfer to any agent on behalf of creditor including a third party to enforce the collection of any debt I owe to creditor.
Pet Medical Insurance:
The Responsible Party is responsible for all charges for Veterinary Service to be paid at the time of service. Redwood Veterinary Hospital will provide the Responsible Party with any paperwork necessary for reimbursement of their claim.
Returned Check Policy:
If a payment is made on an account by check, and the check is returned by your bank for any reason, the Responsible Party will be responsible for the original check amount in addition to a $20.00 Service Charge and all associated restitution fees.
Non-Payment of Account:
Payment is due at the time that services are rendered. It is our policy to refer all unpaid accounts to our collection agency. Should collection referral or legal action become necessary to collect an overdue account, the Responsible Party, understands that we have the right to disclose to an outside collection agency all relevant personal and account information necessary to collect payment for Veterinary Services rendered. Responsible party further agrees that in the event legal action is undertaken to collect monies due, the prevailing party will be entitled to costs of suit and reasonable attorney’s fees. In the event legal action is undertaken, Solano County California shall be the proper county in which they commence legal action.
- I/We understand my financial obligations related to the Veterinary Services rendered as specified above.
- I /We agree to inform you of any changes in my residence or work information
- I/We agree to allow and authorize contact at any phone numbers unless permission is expressly rescinded now or in the future for the purposes of communication regarding my account including, but not limited to obtaining information to keep my account current and to collect a debt that I may owe. This permission shall also transfer to any agent on behalf of creditor including a third party to enforce the collection of any debt I owe to creditor.
By signing below, you verify that you are 18 years of age or older, you agree to accept full financial responsibility for any pet(s) that is/are receiving Veterinary Services. Your signature verifies that you have read the above information, understand your responsibilities, and agree to the terms.
By signing below, you verify that you are 18 years of age or older, you agree to accept full financial responsibility for any pet(s) that is/are receiving Veterinary Services. Your signature verifies that you have read the above information, understand your responsibilities, and agree to the terms.