*Please bring any and all medical records/adoption paperwork with you or email to highwayvet@comcast.net prior to appointment. We cannot check your pet in until we have these records*

Client Information:

Pet Information:

Authorization:

I hereby authorize the veterinarian to examine, prescribe for and treat the above described pet(s). I assume responsibility for all charges incurred in the care of my pet(s). I understand that all fees are expected to be paid in full at the time services are rendered and that payment can be made via cash, personal check, or any major credit card. I understand that at the scheduling of my appointment, I will be required to pay a $25 deposit fee. This deposit is refundable if cancellation is necessary and done so by 3pm the previous business day. I understand that in the event that rescheduling or canceling of any appointment is necessary, failure to provide 24-hour notice will result in a deposit for all future appointments.

I further understand that upon default of payment, I accept responsibility for any collection fees and/or attorney’s fees, including interest, accrued at 18% per annum. Returned checks will incur a $25 fee.