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Advanced Veterinary Care - Client Information Form
Thank you for giving Advanced Veterinary Care the opportunity to care for your pet. Please fill out the following information for our records so that we may better serve you. Be sure to provide as much information as possible so that we can contact you in case of an emergency. Thank You.
First Name
Last Name
Address
Address Line 2
City
State
Zip Code
Home Phone
Work Phone
Mobile Phone
Place of Employment
Driver's License Number *(Required if Paying by Check)*
State
Emergency Contact
Phone Number
*** I do hereby give the Veterinarians on staff complete authority to examine my pet(s) and provide the necessary treatment(s). I accept full responsibility for the fees generated by such services and understand that said fees are due and payable at the time the service is rendered. Any exception to this policy must be authorized prior to the performance of the services. For your convenience, we accept cash, checks, and all major credit cards. Any unpaid balances left in emergency circumstances will be sent to collections if not satisfied within 30 days of the time of services rendered. All routine services must be paid in full at the time of the visit. ** 
Check if you have read and agree to these terms