Authorization to Treat: ALL FEES ARE DUE UPON COMPLETION OF SERVICES AT CHECKOUT. For your convenience, we offer these methods of payment:  Cash, Debit/Credit Card, and Care Credit. Payment in full, by cash, credit card or debit card, is expected when each treatment is performed and the pet is discharged. We do not accept checks and apologize for any inconvenience. On your request, we will provide you with a written estimate of fees before care is provided.

I ASSUME FULL RESPONSIBILITY for the treatment expense involved. I authorize Rehm Animal Clinic to perform such diagnostic, therapeutic, anesthetic, and surgical procedures as are, in their opinion, necessary and advisable for treatment and maintenance of my pet’s health and well-being. I authorize Rehm Animal Clinic to provide veterinary services as requested or in emergency circumstances to follow through with such procedures as are necessary for the well-being of my pet on a continuing basis until further advised in writing.

I certify that I am the owner or duly authorized agent for the owner and as signer have authority to authorize treatment for the animals listed in this consent form. As the responsible party, I agree to pay in full at the time service is rendered, including those deemed necessary for medical or surgical complications or unforeseen circumstances.

*The signer agrees that in the event the doctor/hospital suffers damage, due to treatment that was fraudulently or improperly authorized that the signer will assume full financial responsibility. I certify that I have read, understand, and agree to this payment policy and authorization form.

Payment Policy: Appointments that do not require leaving your pet with us: Examples of these types of visits include a wellness appointment or sick visit where your pet leaves with you and does not stay for services.  Charges for these visits must be paid in full at the time service is rendered. Rehm Animal Clinic accepts payments made by cash, MasterCard, VISA, Discover, American Express, and Care Credit. Rehm Animal Clinic does not accept checks.

Services that require your pet to be left in our care:
These visits include any service where your pet is left in our care including; examinations, rechecks, vaccinations, technician appointments, lab work services, surgery, grooming, bathing, boarding and hospitalizations.  We provide estimates for any of these services upon request.  Estimates are an approximation of what services most likely will be performed and may change if your animal needs more care or testing.  The final bill may be greater or less than the amount specified on your initial treatment plan. It is highly recommended that you request an updated Treatment Plan for every 24 hours of care your pet is hospitalized. 

Rehm Animal Clinic will charge an initial deposit towards the total for hospitalized pets, surgeries, boarding and when accepting a new card.  The remainder of the balance will be charged when your pet is discharged.

 

Stored Payment Consent: I authorize charges to my credit card for goods/services rendered by Rehm Animal Clinic.  I understand I will be charged the full payment of goods and services rendered after each appointment or reservation completed at Rehm Animal Clinic. I understand that it is recommended to request a written estimate for goods/services being rendered prior to scheduling an appointment or reservation for my pet. A receipt for each payment will be emailed to you upon check-out and the charge will appear on your credit card statement.

 

I understand that this authorization will remain in effect until I cancel it in writing.  I agree to notify Rehm Animal Clinic in writing of any changes in my account information or termination of this authorization prior to scheduling an appointment or booking a reservation for my pet. I understand that all payments will be debited from my card, at the time of service, upon check-out. If the appointment falls on a weekend or holiday, I understand that the payment may be executed on the next business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these payment transactions; so long as the transactions correspond to the terms indicated in this authorization form.