Online Form

Financial Responsibility Form

Effortlessly prepare for your pet’s care at Airport Animal Hospital with our user-friendly financial responsibility form. Streamline your visit with ease.

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Financial Responsibility Form

Please fill out the online financial responsibility form accurately. Your thorough completion ensures smooth care for your furry companion.

Name *

First

Last

Email *

Phone

Pet's Name *

I certify that I own or have assumed financial responsibility for the pet described above. I hereby consent to and authorize the veterinarian and staff to hospitalize my pet. I also authorize the administration of vaccinations, medications, tests, surgical procedures, anesthetics, or treatments deemed necessary by the veterinarian for my pet's health, safety, or well-being while under their care. I have been informed that an attendant will not be present at the hospital 24 hours a day. However, all hospitalized pets will be checked on frequently, although staff do not stay overnight. *

I have read and understand

I further realize that I am responsible for payment in full of all procedures & treatments provided during the time of hospitalization at the time my pet is discharged. If I neglect to pick up my pet within five days of written notice that he/she is ready for release and mailed to my address on file, I understand my pet is then considered abandoned. If my pet is deemed abandoned, I authorize Airport Animal Hospital to dispose of it as seen fit. Abandonment does not release me of my obligation for the bill. *

I have read and understand

A deposit of 50% of the estimate for the first 24 hours of hospitalization is required on admission. If an estimate is not available, the deposit for new clients is $100.00 and for established clients $75.00. *

I have read and understand

Signature *

Clear Signature

Date *

Message

Address

Phone

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Financial Responsibility Form

Financial Responsibility Form

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