Client Information Update

Thank you for giving us the opportunity to care for your pet(s). So that we may assist you better, please complete the following:

Fields marked with an asterisk (*) are required.

First name *

Last name *

Title

Occupation

Physical Address*

City*

State*

Zip Code*

Home Phone

Cell Phone*

Email Address

Spouse/Co-Owner's Full Name

Spouse/Co-Owner's Phone

Spouse/Co-Owner's Email

WE REQUIRE ALL SERVICES TO BE PAID FOR AT THE TIME THEY ARE PREFORMED
‍In order to help control the escalating costs of medical care, University Veterinary Care Center no longer allows charging bills to personal credit accounts. To help clients spread the expense of larger bills, we offer credit services through CareCredit. Applying only takes a few minutes, and our staff can assist you with any questions you may have. You agree to reimburse us the fees of any collection agency, which will be added to the account at the time it is placed with an agency for collection and may be based on a percentage at a maximum of 20% of the debt, and all reasonable costs and expenses, including reasonable attorneys’ fees incurred in such collection efforts.

I understand and agree to the statement

Date

Digital Signature

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