Owner Information Form

I authorize and direct the veterinarians at Desert Veterinary Medical Specialists to examine, diagnose,
prescribe, perform therapeutic procedures and/or surgery that their judgement may dictate for the
patient’s care and well-being. No warrant to guarantee has been made as to the result or cure.

ALL FEES ARE REQUIRED TO BE PAID IN FULL UPON COMPLETION OF THE VISIT.

We accept cash, all major credit cards, GE Care Credit, and check. A driver’s license is REQUIRED if you
plan to pay by check. If you choose not to disclose this information, only cash or credit cards will be
accepted. There will be a service charge for any returned checks. A deposit is required at the time of
admission and the balance paid in full at discharge. If you have nay questions about the fees or the
financial policy, please alert a front desk staff member before services are performed. Accounts not paid
within 30 days are subject to a finance charge. In the event any balance due is not paid as agreed, the
undersigned jointly and severally agrees to pay all costs included in the unpaid balance including
reasonable collection / attorney’s fees.

Arizona Veterinary Specialty Center is comprised of multiple practices within the building. Charges that are
assessed for your pet will be billed separately through each practice. If you have nay questions, please be
sure to ask one of our front desk staff members.