2026 Consent to Treat & Financial Agreement

(If more than one horse, I consent that all of my horses brought to De Cillo Equine Clinic may receive Veterinary Services

I, as owner of the Horses registered as Patients with De Cillo Equine Clinic, PLLC., understand that now and in the future, it may become necessary that Veterinary Examination, Treatment, or Consultation be provided. In the absence of specific instruction to the contrary, or in the event I cannot be reached, I hereby authorize my agent:

to act on my behalf in the arrangement of such services with a licensed Veterinarian. Further I agree to be responsible for the payment of all fees incurred. I understand that, if my horse is hospitalized, a payment toward my balance must be made on a weekly basis until my horse is discharged. I further understand that my entire billing account must be paid in full for my horse to be released to me. 

Should my horse need emergency care or advanced procedures that may be expensive, the maximum I wish to spend on this horse is:

PLEASE BE ADVISED THAT AS A REQUIRED SAFETY PROTOCOL AT DE CILLO EQUINE CLINIC ALL HORSES FOR WILL BE SEDATED FOR ALL DIAGNOSTIC IMAGING PROCEDURES INCLUDING BUT NOT LIMITED TO RADIOGRAPHS AND ULTRASOUNDS. THE ATTENDING VETERINARIAN WILL DECIDE THE TYPE AND AMOUNT OF SEDATION REQUIRED. DECILLO EQUINE CLINIC ADMINISTERS THE FOLLOWING SEDATIONS AS NEEDED; XYLAZINE, DORMOSEDAN, BUTORPHANOL, AND ACEPROMAZINE.

I understand the policy for sedation and agree to allow the Veterinarian to sedate as needed.

To reduce confusion and misunderstanding between our dedicated team and loyal clients, we have adopted the following financial policies. If you have any questions regarding these policies, please contact our Office Manager at Accounting@decilloequine.com. We can only provide the best team, state-of-the-art equipment, medication, and care by being paid at the time services are rendered. While circumstances arise from time to time, payment in full is expected at discharge and when the appointment is complete. Payment Options

1. Payment is required at time of service:

Full payment is due at the time of service. De Cillo Equine Clinic does not provide payment plans. For your convenience we accept cash, checks, credit cards (i.e.; VISA, Mastercard, Discover and American Express), and Venmo (Venmo is not the same as cash and receives a surcharge To cover the cost of processing a credit or charge card transaction, credit card payments will include a processing surcharge in an amount not to exceed the cost of processing the charge (charges vary by clients' credit providers, but most are 3.5% Surcharges do not apply to cash, debit cards, or checks.

De Cillo Equine Clinic requires a valid credit or debit card to be kept on file for all accounts. After 14 days with no payment on balances, De Cillo Equine Clinic reserves the right to charge said card for balances with fees accrued for any declined payments.

2.  Returned Checks

If your check is returned, a $35 fee will be issued for returned checks. Following 2 returned checks from the same client, checks will no longer be permitted from said client.

3. Deposits for Treatment

Deposits ($300-$500 for regular urgent care or $1,000+ for specialty procedures/etc.), may be required for same-day urgent or emergent services, as well as new account appointment booking. We require purchases of medication and Routine Vaccinations, Coggins, and Health Certificates be paid in advance.

IF YOU NEED FINANCING OPTIONS:

CareCredit and Scratchpay offer clients financing options. De Cillo Equine Clinic accepts both lenders. Both are subject to surcharges based on financing options (please refer to CareCredit or Scratchpay for details).

Clients that have insurance must pay at time of service and submit the invoices to their provider for reimbursement. De Cillo Equine Clinic does not extend payment terms on insured animals.

4. Interest Charge on Late Payments

Any account balance over 15 days past due will be assessed a 10% Interest Fee. The fee is calculated at 10% of total balance due including fees and interest. Any account that is over 15 days with no minimum payment will incur interest at a rate of 10% annually.

De Cillo Equine Clinic reserves the right to refuse service to any client who has an overdue account.

*De Cillo Equine Clinic reserves the right to keep an animal in hospital at the cost of the client until the client's bill is paid in full. If a client refuses to pay, De Cillo Equine Clinic will accept relinquishment of the animal to the care of the business, De Cillo Equine Clinic, PLLC. De Cillo Equine Clinic reserves the right to refuse service to any client with a history of late or incomplete payment.

De Cillo Equine Clinic wants to stay in touch with you regarding your account. In order for us to service your account or to collect any amounts you may owe, we may contact you by telephone at any telephone number, including wireless telephone numbers that you have or may attain, which could result in charges to you. We may also contact you by sending text messages to any telephone numbers that you have or may attain, or e- mail using any e-mail address on your account. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable. De Cillo Equine Clinic sends discharge and financial paperwork via email so a valid email is required when setting up an account.