General Drop-Off Form

Owner's Name *

First

Last

Date *

Best phone number to reach you at today: *

Email *

Pet's Name *

We will gladly prepare a written estimate if you desire; please ask Doctor or receptionist. Unless prior arrangements have been made, ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. We accept MasterCard, Visa, Discover, and American Express. We also accept Care Credit and Scratch Pay, and extended service fees may apply. There will be a $30.00 service charge for any check returned unpaid or credit card declined. Accounts after 30 days are subject to a 21% APR or $9.00 monthly billing fee, whichever is greater. By signing below, I accept these billing terms

Your payment method today: *

Cash
Card
Check
CareCredit/Scratchpay

Preferred Location *

East Ridge Animal Hospital
West Ridge Animal Hospital

Signature *

Clear Signature

Your signature gives us permission to follow your instructions. Please note that there may be circumstances where the service(s) cannot be performed. If so, you will be informed.

Online Forms

General Drop-Off Form

General Drop-Off Form

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East Ridge Animal Hospital

West Ridge Animal Hospital

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