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New Client Registration

Client / Owner Information
Address
You authorize us to speak to this person about your pet’s care in the event we cannot reach you.
Pet information
Marketing
What social media platforms do you use?
What is your preferred method of payment?

FINANCIAL POLICY:

I certify that I am of legal age and have the authority to enter into this contract/agreement with My Zoo Animal Hospital. I agree to pay reasonable and customary fees for the treatment of my pets. I understand that payment is by cash, MasterCard, Visa, Discover, American Express, or Care Credit and is due when service is rendered unless arrangements are made in advance. I understand that I am liable for any and all fees incurred by Dr. Debbie Leach and My Zoo Animal Hospital in collection procedures including all legal and court cost (including reasonable attorney fees). I also agree to pay interest and billing fees of 1.5% per month, which is 18% annually. (Minimum $1.37) Your signature below indicates your agreement with this policy.

TREATMENT CONSENT:

I hereby authorize the veterinarian to examine, prescribe for or treat the below-described pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of my pet(s). I acknowledge that medical information will not be released to anyone not indicated on this form without my express permission.

By signing this form, my signature indicates that I have read, understand, and agree to the terms and policies outlined above
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