Like Us on Facebook
14370 W Hwy 29, Suite 9 Liberty Hill, Texas, 78642
512-548-5065
New Clients
What To Expect
About
Our Team
Photo Gallery
Reviews
Services
Pet Portal
My Pet’s Medical Records
Request Services
Feedback
Pet Health
Breed Info
Interactive Animal
News
Pet Health Articles
Pet Health Videos
Contact
Online Forms
Press enter to begin your search
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
New Clients
What To Expect
About
Our Team
Photo Gallery
Reviews
Services
Pet Portal
My Pet’s Medical Records
Request Services
Feedback
Pet Health
Breed Info
Interactive Animal
News
Pet Health Articles
Pet Health Videos
Contact
Online Forms