Current Client Registration Form

I hereby authorize the veterinarian on duty and assistants the doctor may designate to administer treatment as is considered necessary. The
reasons such treatment is considered necessary, its advantages and possible complications and possible alternative treatment will be explained to
me by the doctor. I also certify that no guarantee has been made as to the results that may be obtained. I consent to release all medical
information. I hereby certify that I have read and understand the above authorization for treatment.

Professional Fee Policy: The fee for the emergency examination by the veterinarian is $190.00. An additional $25.00 fee will be added from 8pm to
8am and on observed holidays. Additional fees are charged if treatment, medication, and/or hospitalization is necessary. An estimate of total cost
may be obtained from the veterinarian. A deposit may be requested. Fees are to be paid at the time of service. We accept multiple forms of
payment including Cash, VISA*, Mastercard*, Discover Cards* as well as Scratch Pay and Care Credit.

*Please note – when using a credit/debit card as payment that a 3.5% transaction fee is added to the total amount due per transaction.

Please indicate the method of payment below, sign and date.