New Patient Form

New Patient Form

OXMOOR ANIMAL CLINIC

HOSPITALIZATION/TREATMENT/BOARDING RELEASE FORM

PAYMENT IS DUE AT TIME OF SERVICE

VACCINATION HISTORY

BEFORE ANY SURGICAL PROCEDURE, WE RECOMMEND LEUKEMIA TESTING FOR CATS AND HEARTWORM CHECKS FOR DOGS THAT ARE NOT CURRENTLY ON PREVENTATIVE

If surgery is to be performed on the above described pet, I do understand that there is a certain amount of risk in any surgical procedure. I do hereby authorize Oxmoor Animal Clinic, its representative or agent to perform the surgery and/or other necessary services for the safety and well being of the above described Pet. I understand that any animal not picked up ten (10) days after release date shall be considered "abandoned", and shall be disposed of at the discretion of the clinic. My financial responsibility shall not be altered in any way by such disposal and my indebtedness shall include all charges incurred up to and including the date of such disposal. Any unpaid balance over 30 days will be charged a 1.5% finance charge (18% ANNUAL RATE). If it should become necessary to collect this account through a collection agency, the undersigned agrees to pay for the cost of these collection fees and waives all rights of exemption as to personal property.

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