• Horse Information

  • Billing Information

  • Date Format: MM slash DD slash YYYY
  • Authorization and Payment

    I hereby authorize the veterinarian to examine, prescribe for, or treat the above described animal. I assume responsibility for all charges incurred in the care of this/these animals. ALL PROFESSIONAL FEES ARE DUE AT THE TIME THAT SERVICES ARE RENEDERED. We will gladyly prepard a written estimate if you desire. (Please ask our Dr. or Staff) I also understand that these charges will need to be paid in full at the time services. In case of extensive medical or surgical procedures where full payment may be difficult at discharge, our office accecpts Visa, Mastercard, American Express, and Care Credit. There will be a service charge for any check returned unpaid. Also any unpaid balance can result in a monthly service charge.

  • Date Format: MM slash DD slash YYYY
  • Registered Name/Registered NumberBarn NameBreedAgeSexAnticipated discipline/careerStabled atAppointment Reason/GoalIs this for a Pre-Purchase Exam?