It is understood that there may be unforeseen complications and that further treatment may be necessary during the hospitalization. I accept and assume full and total financial responsibility for any and all services rendered by the clinic, its staff or employees in the treatment of the above described animal and agree to pay the fees in full at the time of my pet’s discharge.
(Special diets should be brought into the clinic with you, if not a bag may be added to your final bill)
(Medications should be brought into the clinic with you, if not medications will be billed accordingly)
I, the owner, being a person over the age of eighteen years hereby declare the information given above is accurate and complete and I do not know of any other condition which may affect the procedure to be performed. I authorize Camden Valley Animal Hospitals Pty Ltd or their agent being a registered veterinary surgeon to administer to my pet who's details appear below a suitable anaesthetic and to perform the procedure/s indicated above, accepting any risk involved. By signing this admission form I also accept we are dealing with living animals and there can be complications even with the most routine procedures, handling these complications can increase the fees incurred. I acknowledge that where an estimate is given it assumes a certain amount of anaesthetic, disposables, medications, hospitalization surgical equipment, time etc. is utilized anything extra used in providing the service will be charged appropriately. I hereby accept all the expenses associated with performing the said procedures and dealing with any complications that may arise and I assume the responsibility for settling all the debts incurred for the services rendered, at time of discharge of My pet from the hospital, including any extra fees beyond any estimate implied, any fees incurred in dealing with complications, boarding fees incurred until such time as the account is paid in full (The boarding fees accumulate at MINIMUM of $29.00 per day (boarding fees vary depending upon the size of the animal and amount of care needed please enquire about the specific fees at reception). I also agree to pay any fees incurred in the operation and or settlement of the account (these include all fees for veterinary services, veterinary supplies, goods, boarding fees, all account keeping fees, overdue account keeping fees, interest charged, debt collection fees, legal fees, bank fees and any other fees incurred).
I confirm that I have read, understand and agree to the above conditions.
Camden Valley Animal Hospital
🐾Special care for special friends. Fear Free clinic.
Address: Shop 2 Exchange Parade Narellan 2567
Phone Number: (02) 4647 6199
Email Address: email@example.com