New Client Form

Please fill in the form below.
 

Full Name
Address
Phone Number
Pet Information
Authorization

Client Agreement: I understand that AAC utilizes the services provided by the Madison County Attorney for returned checks and all accounts sent to the county attorney are subject to additional fees and penalties. I also understand any balance that remains unpaid for any reason will be sent to a professional collection agency and I agree that I will be responsible for additional fees and penalties incurred to Advanced Animal Care for collections on this account, as well as interest accrued at 1.5% monthly (18% annum). Advanced Animal Care reserves the right to present past due accounts to small claims court in place of a collection service. I have read the above and understand the hospital payment policy. I acknowledge that I am the responsible owner of the pet(s), or authorized agent of the owner, associated with the below named pet(s) and represent all other owners. I assume responsibility for all charges incurred in the care of the animal. You must be 18 years or older to legally sign this consent. All fees are due at the time services are rendered. AAC does not offer payment plans, but clients may apply for Care Credit.

Click below to consent to treatment of your pet and to authorize us to release your pet's records if necessary *

I, being responsible for the required animal, have the authority to grant my consent to receive, prescribe, and treat my pet. Further, I accept full financial responsibility for authorized medical treatments. I also authorize AAC to transmit my animal's records to other veterinarians if necessary.