Thank you for the opportunity to care for your pet. We'll be happy to answer any questions you have about your pet's health. Please take the time to fill in this form completely. Thank you!

*ALL FEES ARE DUE AT THE TIME OF SERVICE*

I understand that payment is expected when services are rendered, unless other arrangements are made in advance. Charges of 3% per month will be applied to all accounts unpaid after 30 days. There is a $25.00 monthly late fee for non-compliance of payment agreements. A $37.00 service charge is added for any returned checks. I further understand that unpaid accounts may be turned over for collection and credit bureaus notified within 30 days. I, the undersigned, will be responsible for ay collection fees in addition to the amount owed. These fees will be equal to or greater than the amount owed.

Taos Veterinary Clinic, P.C., 41 N. Highway 522, P.O. Box 2678, Taos, NM 87571 (575) 758-7310

I understand that payment is expected when services are rendered, unless other arrangements are made in advance. Charges of 3% per month will be applied to all accounts unpaid after 30 days. There is a $25.00 monthly late fee for non-compliance of payments agreements. A $37.00 service charge is added for any returned checks.

I further understand that unpaid accounts may be turned over for collection and credit bureaus notified within 30 days. I, the undersigned will be responsible for any collection fees in addition to the amount owed. These fees will be equal to or greater than the amount owed.

I hereby consent and authorize the veterinarians and staff of Taos Veterinary Clinic, P.C. to receive, prescribe for, treat, or operate upon my animals(s).

You are to use all reasonable precautions against injury, escape or destruction of the animal(s), but you will not be held liable or responsible in any manner whatever, or any circumstances, on account of the care, treatment or safekeeping of all animal(s) brought in to this clinic or otherwise in connection therewith, as it is thoroughly understood that I assume all risks.

Financial responsibility for services rendered is due at the time of discharge.

In the event a medical or surgical condition arises and the client is not available for consultation, we will perform "best medicine" procedure on behalf of the patient.

I also understand that Taos Veterinary Clinic, P.C. is not staffed twenty-four (24) hours a day and after hour treatment of patients is at the discretion of the veterinarian.

I grant Taos Veterinary Clinic, P.C. to post pictures of my pets on social media.

Taos Veterinary Clinic, P.C.

41 N. Highway 522, P.O. Box 2678,

Taos, NM 87571

(575) 758-7310