Consent and Authorization
I hereby represent that I am over the age of 18 and authorize the veterinarian to examine, prescribe for or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid when the services are rendered and that a deposit will be required for treatment. Due to the nature of medical services, I understand that once a service is performed, the fee for that service is non-refundable.
In the event that this account is placed with an attorney or a collection agency because of an unpaid balance remaining on my pet's account, I hereby agree and promise to pay interest of 1.5% per month of the outstanding balance to be calculated starting from my pet's last date of service. In addition, I also agree and promise to pay a collection fee of $100 or 33% of the total balance due, whichever is greater, upon placement with an attorney or collection agency because of an unpaid balance remaining on my pet's account. In the case of a returned check. I acknowledge that there will be a fee of $35 imposed by and payable to GSVS. By signing my name below I hereby acknowledge the above stated policies.