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.

Primary Owner*
First Last
Phone*
Secondary Owner*
First Last
Phone*
Emergency Contact Name*
First Last
Phone*
Consent*
I understand that payment is due at the time services are rendered.
Consent*
A deposit is required for all patients requiring hospitalization. If your pet is hospitalized for several days, you are expected to pay for services in advance or on a daily basis. We can provide a written estimate of the charges for every patient. These written estimates are subject to change and merely represent expected charges at the time estimate is printed.
Consent*
I understand the payment policy and I agree to pay for treatment at the time services are rendered both today and in the future. In the event of non-payment following notifications of delinquency, I understand that the delinquent account is subject to collection either by CTVC or an independent collection agency and that I will be responsible for payment of any collection fees.
An additional payment option is provided through the company, Care Credit. Apply for credit through: https:llwww.carecredit.com/apply/
Signature of Responsible Party:*
Date*
Date Format: MM slash DD slash YYYY

Have a Question? Need to book an appointment?

If you’re ready to see our expert veterinary team in Liberty Hill, call Comanche Trail today to make an appointment.

Operating under reduced hours due to COVID-19, appointments are strictly curbside service until further notice

Contact Us

14370 W Hwy 29, Suite 9
Liberty Hill, TX 78642

Call us: 512-548-5065
Email Us: [email protected]

Fax: 512-548-5071