New Family Member Form

Please check any symptoms or problems you have noticed about your pet


I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all the charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment. I agree by signature below failure to pay at time of service will cause late chargers of 18% of balance to be assessed if not paid in full within 30 days. Balances that go over 30 days are subject to legal and collection proceedings. Necessary costs such as court fees, legal fees or any other fees incurred by D.C.A.H in the collection of this account will be client’s responsibility in full

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