Thank you for giving Family Pet Care the opportunity to care for your pet(s). In order to serve you, please fill out the following information as completely as possible. Please print. Signature required.
All fees are due at time services are rendered.
I (We), the undersigned, hereby agree to pay all amounts and charges here after incurred by members of my family or representative for services rendered by this hospital. Failure to make payment when requested is basis for legal action and the undersigned agrees to pay all costs of collection fees and hereby waives their right of exemption under the law of the state of Alabama and any other state. I give Family Pet Care permission to verify employment.