|
|
|
|
|
E-Mail Address (required) :
|
Please provide a valid email address so we may email reminders to you |
Employer (required)
|
Employer Address
|
Spouse Employer
|
Spouse Employer Address
|
How did you hear about us? (required)
|
Whom may we thank if you were referred?
|
Valley Veterinary Hospital Financial Policy Missed Appointments:
A $40 missed appointment fee will be assessed for a missed appointment if you fail to contact us to reschedule or cancel the appointment at least 24 hours prior to the set appointment time unless prior arrangements have been made. |
Payment is expected at the time services are rendered. We accept cash, check, Visa, MasterCard, Discover, American Express, and Care Credit. |
If financing is needed we can assist you in applying for Care Credit. Returned checks are subjected to additional charges from CheckTec and/or your financial institution. |
Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. |
Any balance that I leave unpaid will be forwarded to Valley Veterinary Hospital, PC's collection agency, and may incur a collection fee for which I am liable, in addition to monthly finance charges, court costs or attorney fees. |
I am the responsible party and have read and agree to the above financial policy. |