Patient Registration

( E-Pet Health Online Portal )

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:

PET INFORMATION

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.