• New Client Registration Form

  • PERKINS ROAD VETERINARY HOSPITAL

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  • Please list any known allergies to drugs or vaccines.

  • > I am the owner of the animal named above, and I agree to hold Perkins Road Veterinary Hospital and its personnel harmless for any disease contracted by said animal during its stay that could have been prevented by a proper preventative medication program. I realize that vaccinations given upon admission to the hospital will not have enough time to fully protect that animal on the particular visit.

    >I realize that pets are only discharged during regular office hours and that any pet left in excess of ten days of the stated discharge date will be considered abandoned.

    >I also realize that FULL payment is due UPON RELEASE OR END OF SERVICE. Applications to defer payment MUST BE made in ADVANCE and all unpaid balances will be subject to a finance charge of 1.5% per month. (18% year), with a minimum monthly processing fee of $3 per

    *In the event of a medical emergency I authorize the doctors and staff to perform any neccessary services or procedures that my be in the best intrest of my pet and understand that I am finacially responsible for any charges incurred.*

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