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MM slash DD slash YYYY
Address
MM slash DD slash YYYY
Species

Gender
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Is your dog on Heartworm Prevention?
Has your cat been tested for Leukemia and FIV?
Is your pet Microchipped?
Is your pet current on Vaccinations?
List the names and ages of any other animals that you own
Name
Ages
 

I assume the responsibility for all charges incurred in the care and treatment of my animal(s). I also understand that these charges will be paid at the time of release and a deposit may be required for treatment. In the event, any account is not paid when due, the prevailing party shall be entitled to recover its reasonable attorney fees and any court costs, including costs of appeal or another review. In the event that your account is placed for collection with a collection agency, you agree to pay any collection fees that may be assessed in addition to the amounts owing.