I am the owner/agent for the above described animal, and am over the age of eighteen. I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet(s). I further acknowledge and accept full financial responsibility for all services rendered. I agree to pay any service charge or interest (1.5%/mo) that may be assessed to any balance due over 30 days past service date. In the event of default, I understand the balance due may be placed with a collection agency and I agree to pay the 30% collection fee. In the event of legal action, I agree to pay reasonable attorney fees and court costs. By typing in my name/signature I authorize this agreement.

Signature Will Be Required Upon First Visit