Brushy Creek Veterinary Clinic New Patient Info

FINANCIAL INFORMATION

Professional fees are to be paid at the time services are rendered unless other arrangements have been made in advance. An estimate of fees will be given upon request.
Preferred Method of Payment *

Cash Check Debit Credit Card
Driver's License Number *
Driver's License State *
By signing below and submitting this form, I hereby authorize the doctors and staff of Brushy Creek Veterinary Clinic to administer treatment, diagnostic, surgical and anesthetic procedures as they deem necessary. I realize that no guarantee can be made regarding results of these procedures. Further, I agree to assume full financial responsibility for these procedures. Use your mouse or finger to sign electronically below. *
Click or tap the Submit button below to continue. You will be redirected to a confirmation page with instructions to request your first appointment for this patient.
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