Thank you for giving us the opportunity to care for your pet(s).
So that we may become better acquainted, please complete the following:

Client Information
Name:
Spouse's Name:
Address:
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How did you become aware of our clinic?
Pet Number 1
Pet Number 2
Pet Number 3
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We thank you for allowing us the opportunity to care for your pet. In order to provide the best possible animal medical care, we require payment in full at the end of your pet's examination and/or at the time of discharge. We routinely provide written estimates for all patients and will discuss the estimate with you prior to the treatment. 

For some treatment or hospitalized care, a 50% deposit may be required. For your convenience, Shohola Veterinary Hospital accepts several forms of payment including cash, care credit, and Apple Pay. As well as all major credit cards. 

"I am aware that my balance will be doubled if this account is assigned to an outside agency for collections."

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