Owner's Information

























Pet's Information













































Authorization

Please Read Carefully

All professional fees are due at the time that service is rendered.


In cases of needed extensive medical or surgical procedures is required, we will provide you with a written estimate. We accept Mastercard, Visa, American Express, Discover, and Care Credit. We do not bill under any circumstances! All animals that are kept for any period of time within our hospital must be current on Rabies, Bordetella, & Distemper/Upper Respiratory vaccines.


I will comply to all 280 AMC's policies. I certify that the facts contained in this document are true & complete to the best of my knowledge. I give 280 AMC authorization to retrieve my pets medical records so that 280 AMC will be knowledgeable of my pets state of health & vaccine history.