19582 Ventura Blvd.Tarzana, CA 91356
(Capri Plaza Shopping Center)
BIRDS • CATS • DOGS • EXOTICS
Reptiles, Rabbits & Rodents
Yoko Tamura, DVM and Associates
Payment required at time of service. We accept the following methods of payment
Cash, Debit, or Credit Card (Sorry, Checks are not accepted.)
PERMISSION FOR PET(s) NAME & PICTURE(s) TO BE DISPLAYED ON SOCIAL MEDIA ACCOUNTS *:
I ALLOW YES NO
ARE YOU A PREVIOUS CLIENTS? * YES NO
ARE YOU 18 OR OLDER? * YES NO
HOSPITAL POLICY: PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE RENDERED. A DEPOSIT IS REQUIRED ON ALL HOSPITALIZED PATIENTS. BALANCE IS TO BE PAID UPON DISCHARGE.
If any payments are unsuccessful, I will make reasonable effort, in good faith, to provide the due funds to Capri Plaza Pet Clinic at the soonest possible time. I understand that if I am more than 45 days delinquent on any payment to Capri Plaza Pet Clinic, my account will be forwarded to a collection agency that may use any legal method to collect on this debt plus any costs, legal fees or interest (1.5%/month) that may have accrued. This document, including client’s signature, may be stored electronically. I hereby acknowledge that any such electronically stored document will be as enforceable as the original of said document, and if any dispute should
arise we agree to binding arbitration.
I have read and understand the above hospital policies.