By completing and submitting this form, I certify that I am 18 years of age or older, and that I am the person who is responsible for the animal listed above. I am responsible for communicating with the Fishtown Animal Hospital team concerning my pet's diagnosis, treatment and veterinary medical care. I understand that I have sole responsibility for all charges incurred in care of this animal. I understand that full payment in the form of cash, credit card and/or care credit is due at the time of service, and that at the discretion of the hospital, a deposit may be required.

By completing and submitting this form, I acknowlege the following Fishtown Animal Hospital policies:

Deposits: For all new clients, we take a $65 deposit in order to schedule the first appointment. It is the price of the exam, and will go toward the overall cost of your appointment. This deposit is nonrefundable and will be forfeited if you miss your appointment or if your appointment is canceled or rescheduled with less than 24 hours notice.