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Talega Animal Hospital - New Client Registration Form
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11Questions
  • 1
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  • 2
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  • 3
    • Cellphone
    • Home Number
    • Work Number
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  • 4
    Do you have a friend, relative, neighbor or pet sitter, who is authorized to bring in pet(s) and make treatment decisions in your absence?
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  • 5
    • Drove By
    • Yelp
    • Google
    • Yahoo
    • Military Brochure or Military Connection
    • Animal Shelter
    • Neighborhood Mailer or Brochure
    • Our Website
    • Other
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  • 6
    • YES
    • NO
    • Tell me more
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  • 7
    1 of 4
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  • 8
    • I understand that payment is required in full at the time services are rendered. WE DO NOT BILL.
    • I hereby authorize Talega Lantern Animal Hospital to render medical & surgical care for my pet(s) as deemed necessary by the veterinarian.
    • I understand I may be asked to leave a deposit before surgical procedures and lengthy boarding reservations.
    • I understand Talega Lantern Animal Hospital does not accept out-of-state checks or offer payment plans.
    • Veterinary service during nighttime hours, some daytime hours, and/or weekends, is provided at the discretion of the veterinarian in charge. Continuous presence of personnel may not be provided during these hours.
    • I understand personal items (blankets, toys, etc.) may not be returned if left at Talega Lantern Animal Hospital.
    • I understand that fecal testing for parasites is recommended every 6 months for my pet and according to the Centers for Disease Control and Prevention feline and canine parasites can be transmitted to humans and can cause potentially serious health problems.
    • I understand that eliminating intestinal parasites from my pet is essential and is extremely important for the health of my pet(s) and my family.
    • Declaration: If my account should become delinquent, I am responsible for all collection costs & attorney fees. A finance charge of 1.5% per month (or a $5.00 monthly service charge, whichever is greater), plus a $3.00 monthly billing fee is due on all balances owed over 30 days. My signature indicates I understand these policies and agree to them.
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  • 9
    Clear
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  • 10
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    Pick a Date
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  • 11

    Talega Animal Hospital Privacy Policy: We do not divulge client information except as required by law.

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