New Patient Form

By signing below, I confirm that this information is correct, and that I am the client responsible for the pet(s) listed on my account I understand that FULL PAYMENT IS DUE AT THE TIME OF SERVICE IS RENDERED and that a DEPOSIT IS REQUIRED FOR ANY HOSPITALIZED PET. We will gladly prepare a written estimate of service fees if you desire, please ask our doctor or receptionist. All unpaid balances are subject to a 1.5% per month interest charge. There will be a service charge for any check returned unpaid. In the event of default of any payment required by this agreement when due, the entire unpaid balance of principal and interest shall become due and payable immediately, without notice, at the election of Meridian Veterinary Clinic & Hospital. If Meridian Veterinary Clinic & Hospital turns the account over to collection, MVC&H shall have the right to recover the cost of collection including but not limited to collection agency fees and reasonable attorney’s fees. I authorize the release of my pets’ medical records to Meridian Veterinary Clinic & Hospital and hereinafter waive the written release requirement. To prevent the spread of infectious diseases, all hospitalized patients must be current on vaccines and free from internal and external parasites. The signature below authorizes this level of preventative care and the appropriate charges will be assessed in the discharge invoice.