Pet Information and Health History
For any additional pets please go to the additional pet form located under Client Center.
Owner Agreement and Consent
*All fees are due upon release of patient/guest. We accept all major credit cards (Visa, MasterCard, Discover, and American Express), Care Credit, cash and personal check ($30.00 fee for all returned checks). A deposit is required for major medical or surgical procedures.
*We require a Driver's License number on all personal checks. We also require personal identification when paying by credit card. If you elect not to give us this information you may pay by cash.
*I acknowledge and accept full financial responsibility for all services rendered. I agree to pay any service charge or interest (18% per year) that will be assessed to any balance over 30 days past service date. In the event of default, I understand the balance due may be placed with a collection agency and I agree to pay the balance and the cost of collection fee. In the event of legal action, I agree to pay reasonable attorney fees and court costs.
*I understand that Petsburgh Pet Care is not responsible for any accidental illness or injury incurred by my pet(s) beyond the control of the staff while staying or visiting at Petsburgh Pet Care unless due to the gross negligence or intentional misconduct of Petsburgh Pet Care.
*By entering your email address in the above space, you give us permission to send reminders, promotions and other offers. You may unsubscribe at any time.
*Please sign below
I grant permission to Petsburgh Pet Care to use my pet's name, information, picture and/or video for use in Petsburgh Pet Care's publications such as brochures, newsletters, display boards, website, or other electronic forms of media.
Please remember to send vaccination records/medical records. You can fax them 765-742-1730 or email ([email protected]) them to us.
I understand for medical services there is a required 60.50$ deposit, and for grooming there is a $50 deposit to be paid at the time of scheduling: subject to wave/return if canceled 24 hours in advance.
You do not have an appointment scheduled until we call you back and set this up and take a deposit. Thank you.