Responsible Party Information

All information regarding the person(s) responsible for payment for services rendered must be completed before the patient is seen. In all cases, professional fees, product purchases, all costs related to treatment, testing, grooming, and boarding are the responsibility of the client, spouse, or co-owner of animal(s). The information contained. within this form is required for all clients, is confidential, and will not be shared with any outside sources.
  • An additional payment option is provided through the company, Care Credit. Apply for credit through:
  • Date Format: MM slash DD slash YYYY