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New Client Registration

Client / Owner Information
You authorize us to speak to this person about your pet’s care in the event we cannot reach you.
Pet information
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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.


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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