Patient / Client Form

Payment Is Expected At The Time Of Service In The Form Of Cash, Check Or Credit Card. In Extraordinary Circum-
Stances Requiring Payment Plans, Outstanding Balances On The Account Will Accrue Interest Every 30 Days At The Rate Of 2% Per Month, Or 24% Apr. If Payments Are Not Being Made In A Timely Fashion, Accounts Will Be Turned Over To An Outside Collection Agency. In That Event, The Undersigned Becomes Responsible For All Costs Related To Collection, Including Court Costs And Attorney Fees Accrued By Georgetown Veterinary Hospital. 1, The Undersigned, Do Understand And Comply With The Above Statement.

I Acknowledge That I Have Received Information About Georgetown Veterinary Hospital’s Noncontinuous Medical Care Hours.