Client (Human) Information
Patient (Pet) Information
Please help us by completing the following information, as prior information can be helpful in reaching a diagnosis.
*Please bring in all medications / supplements to your pets visit.*
I am the owner or the agent of the owner, of the above-described Pet and have the authority to execute this agreement. I authorize Royal Vista Veterinary Specialists to examine and treat the above pet. I accept full financial responsibility for the pet. I understand that payment for diagnostic tests and treatment that I authorize in writing or verbally will be due at the time the above pet is dismissed for the hospital. If another veterinarian has referred me to this hospital, I understand that they will receive a summary of the care and treatment provided in order to ensure that the above-described pet's care can be continued without interruption. I also understand that my identification of a referring or family veterinarian is considered to be my authorization to release records and information to that veterinarian.
Payment is due as services are rendered. For hospitalized patients, a deposit is required in advance. The balance is due upon discharge from the hospital. You may pay by cash, check, Visa, MaserCard, Discover or Care Credit. In order to avoid any misunderstanding, please let us know immediately if these terms are not satisfactory.
This field is for validation purposes and should be left unchanged.