Please fill out this form as completely and accurately as possible .
• I understand that payment is due at the time of service. If the balance is not paid in full within 7 days, I allow Companion Dentistry & Oral Surgery to charge the balance to the credit card on file.
• Appointments must be canceled or rescheduled at least 72 hours in advance of the appointment. If I am unable to comply with this, I understand a cancellation fee may be applied to my account, and I may be billed for any expenses associated with preparation for the appointment.
*I hereby authorize the veterinary practice of Companion Dentistry and Oral Surgery to provide veterinary care for my animals. Veterinary care includes the performance of procedures and the use of appropriate anesthetic and other medications as deemed necessary in the practice of veterinarian professional judgment.
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*By signing this Veterinary Service Agreement, I agree I have received and understand, and agree to comply with the attached terms and conditions of the agreement as a legally enforceable contract with Companion Dentistry & Oral Surgery and Dr. Louise Marron, DVM DAVDC. I understand that services will not be provided without my signature and payment information. If I do not want charges to be automatically charged to my credit card, I understand the information above will be used to collect any late or non-payments.