"*" indicates required fields NameThis field is for validation purposes and should be left unchanged.I/we accept and acknowledge that payment is due at the time service or at the time of discharge from the hospital.InitialI/we accept that if I fail to show up for scheduled appointments, I will be asked to leave a non-refundable deposit prior to scheduling future appointments.InitialI/we understand there is a $20.00 service fee charge for any returned check.InitialI/we understand that if I am more than 10 minutes late for my pet’s appointment, I/we may be required to reschedule. CVH will always attempt to accommodate late arrivals but in certain circumstances it may not be possible without creating significant delays for later appointments.InitialSignature*SignatureDate* MM slash DD slash YYYY Date MM slash DD slash YYYY Thank You!
