I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of the animal. I understand that ALL PROFESSIONAL FEES ARE DUE NOW, unless prior arrangements are made. I also understand a late fee of 1.5% will be added to any account that becomes (30) thirty days PAST DUE and late fees will continue to be charged until your account is PAID IN FULL. Also please be advised that all appointments missed may be subject to a fee of $12.
I have read this statement and -