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YOUR INFORMATION
How did you hear about us?
PATIENT INFORMATION
Sex
Spayed/Neutered
Social media authorization
CREDIT CARD AUTHORIZATION FORM

Ingleside Animal Hospital requires a deposit of $79.50 PER pet from new customers to hold an appointment with our doctors.  This deposit is non-refundable if the appointment is missed, and we have not received notification within 24 hours of the scheduled time.  This deposit will be applied to any services rendered at the time of the appointment.

IMPORTANT: Please complete the Credit Card Authorization form and this form.  Once we have received BOTH forms, your appointment will be confirmed and put into our scheduler.

Credit Card Authorization Form
AGREEMENT
TO PREVENT THE SPREAD OF INFECTIOUS DISEASES AND PARASITES, HOSPITALIZED AND BOARDED ANIMALS MUST BE CURRENT ON ALL VACCINES AND FREE OF EXTERNAL PARASITES.

I authorize and direct the veterinarians at Ingleside Animal Hospital to diagnose, prescribe, perform therapeutic procedures, and/or surgery that their judgment may dictate to be advisable for the patient’s well being. No warranty or guarantee has been made as to the result or cure.

Accounts that are not paid in full may be placed with a collection agency. I further agree to pay all collection costs, responsible attorney fees, and other costs that may be incurred to enforce collection of any outstanding amounts.

I Agree
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