I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this New Client Form, hereinafter referred to as “the animal.”

I certify that no other person has a right of property to the animal.

I understand that I am financially responsible for all charges for services rendered and that payment is due at the time of service. Cash or Credit only. No checks please.

I agree to pay in full for services rendered, including those deemed necessary for medical and/or surgical complications or unforeseen circumstances at time of discharge.

Any estimate of charges for presently planned procedures is only an approximation and the final bill may be greater or less than this amount.

I am aware that a deposit may be required at the time of admission for surgical, drop off examinations and emergencies.

I further understand should my account become delinquent; I shall pay all reasonable fees or collection fees, if any.

Balances due over 30 days will be charged $25 a month until paid in full, unless arrangements have been made with Dr. Nickerson.

In order to keep our hospital disease free, we ask that your pet be current on Heartworm and flea/tick medications. If any external or internal parasites are found while your pet is in our care, we will treat them appropriately, unless pets’ illness deems otherwise. This treatment will be at the owner’s expense. All pets must be up to date on Rabies vaccine or provide us with proof.

I further certify that I have read and understand the terms of this New Client Form.