Client Consent Form I am the owner, or representative of the owner, over the age of 18, of the animal(s) presented and have authority to execute this consent. I authorize and direct the veterinarians at Southern Hills Animal Hospital to administer authorized treatment as needed on the basis of findings during the course of evaluation: to diagnose, prescribe, and perform therapeutic procedures as their judgement may dictate to be advisable for the patient’s well-being. I understand I will be advised as to the nature of the procedures and risks involved. I understand that no warranty or guarantee will be made as to the results or cure.*I agree and understand (Client must initial)I UNDERSTAND THAT I ASSUME RESPONSIBILITY FOR THE BALANCE OF ALL FEES FOR SERVICES AND PRODUCTS AT TIME SERVICES ARE RENDERED OR PATIENT IS DISCHARGED. (No postdated checks or "courtesy holds" on checks will be accepted.) Accepted forms of payment are Cash, Check, Visa, MasterCard, Discover, American Express, as well as CareCredit & ScratchPay. I agree to reimburse Southern Hills Animal Hospital the fees of any collection agency, which may be based on percentage at a maximum of 30% of the debit, all cost, and expenses, including reasonable attorney’s fees, which incur in such collection efforts.*I agree and understand (Client must initial)Upon New Client Registration a current driver's license and a social security number are required. If I decline to provide a photocopy of my valid ID and/or SSN, Southern Hills Animal Hospital will provide an estimate and require prepayment for expected services. (In the case of an emergency or if your pet's illness isn't clear, we will require a deposit of $300.00 prior to treatment.)*I agree and understand (Client must initial)A written estimate can be prepared AT MY REQUEST before treatment/procedures are performed. I realize that the actual expenses may differ from the estimate dependent on the patient’s condition and length of stay in the hospital. Southern Hills Animal Hospital will try to contact me if emergency treatment is required. I will be responsible for expenses incurred in an emergency when I cannot be reached or there is no time to contact me. I will be fully responsible for monitoring the ongoing expenses and will be fully responsible for all expenses incurred through the animal’s diagnosis and treatment.*I agree and understand (Client must initial)I understand Southern Hills Animal Hospital reserves the right to refuse any requested services, including euthanasia if the veterinarians (and staff) deem it medically unnecessary.*I agree and understand (Client must initial)I agree to contact Southern Hills Animal Hospital by 3:00pm on the day prior to my scheduled appointment to notify of any changes or cancellations (Monday appointments by 3:00 pm on Friday). If NO prior notification is given, I understand I will be charged $25.00 for the missed appointment. If I am more than 15 minutes late to any scheduled appointment I understand I will be seen as a work in (work in means you will be worked in between other standing appointments). Failure to keep an appointment will be noted on my account. After 3 missed appointments I understand I will be required to pre-pay before new appointments are made.*I agree and understand (Client must initial)It is my responsibility to notify Southern Hills Animal Hospital if I am unable to pick up my pet on the agreed-upon date. If there is no contact within 5 days after the agreed-upon date, my pet(s) will be considered abandoned and appropriate action will be taken.*I agree and understand (Client must initial)I authorize the release of vaccination information to other veterinary hospitals, boarding facilities, groomers. I authorize Southern Hills Animal Hospital, its assignees and transferees to publish the same in print and/or electronically.*I agree and understand (Client must initial)Southern Hills Animal Hospital may use my pet’s photo and first name in marketing materials, which may include but are not limited to, social media accounts like Facebook and Instagram, sohillsvet.com, in-hospital signage and other forms of advertising.*I agree and understand (Client must initial)I have read all terms and agree to all conditions described.* I agreeSignature*Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.Δ
