New Client/Patient Information Form

Client Information
Pet's Information

Additional Pets? Please complete new form for each additional pet.

Social Media
We love social media and we love our patients! Do we have permission to share your pet’s image and story on our social media sites? Only your pet’s name will be used; your name and personal information will never be shared.

I understand and agree that it is the policy of this animal hospital to receive payment at the time services are rendered. Furthermore, a deposit may be required upon admission to this animal hospital for treatment.

Our Financial Policy

Thank you for choosing County Animal Hospital.  We are committed to providing the highest quality health care for your pet.  The following is a statement of our Financial Policy, which we require that you read, agree to, and sign prior to treatment.

  • All clients must complete our New Client / New Pet Registration form and Our Financial Policy form.
  • Full payment is due at time of service.
  • We accept cash, personal checks, Visa, MasterCard, American Express, and Discover.
  • We do offer an extended payment plan with prior credit approval through the Care Credit card program.
  • If payment is not made in full, an annual interest charge of 15.60% will be assessed.  (1.3% on all charges over 30 days due).

Adult Clients

Adult clients are responsible for full payment at the time of service.

Minor Clients

The adult accompanying a minor and the parents (or guardians) are responsible for full payment.

For unaccompanied minors, non-emergency treatment may be denied unless charges have been pre-authorized to an approved credit plan, bankcard, or payment by cash or check at the time the service has been verified.

Missed Appointments

Unless canceled at least 24 hours in advance, we reserve the right to charge for missed appointments at the rate of a normal office visit.  Please help us to serve you better by keeping your scheduled appointments.

Thank you for understanding our Financial Policy.  Please let us know if you have any questions or concerns.

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