New Client Form

Treatment Authorization

I am the owner or agent for the animals described above, and I have the authority to execute this consent. I hereby authorize the Veterinarians and staff of St Francis Veterinary Clinic to examine and render treatment. I also authorize the use of appropriate materials and surgical procedures, including anesthetics and other medications as deemed necessary by the Veterinarians. I realize that results cannot be guaranteed.

Payment Policy

I understand that cash, credit cards, or personal checks are accepted. If paying by check, a valid driver’s license must be presented, and the name on the license must be the same as the name on the check. Credit cards are verified electronically. If authorization is declined for any reason on a check or credit card, another method of payment is required. WE DO NOT ALLOW CHARGING AND CANNOT SEND BILLS. FULL PAYMENT IS REQUIRED AT THE TIME SERVICES ARE PERFORMED. A verbal or written medical care plan will be provided upon request. A prepayment of approximately one-half of the total estimated fees may be required initially, with the remaining balance due and payable upon release of the animal. If you are unable to comply with this payment policy, please notify the doctor or staff.

I grant St. Francis Veterinary Clinic permission to use my pet’s picture, story, and medical information on social media or in publication.

I have carefully read the Treatment Authorization and the Payment Policy, and by signing below, agree to all conditions.