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New Patient Registration Form

*(Must be 21 years of age or older) 
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    *(Must be 21 years of age or older) 
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    Please Select
    • Please Select
    • SPAYED
    • NEUTERED
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    • Front only
    • All 4 paw declaw
    • NOT DECLAWED
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    Please indicate date or month and year of vaccine
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    • Breeder
    • Shelter
    • Store
    • Stray
    • Private Home
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    ***PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE RENDERED*****

    In admitting my pet(s) for diagnostics, treatment, or surgery, I authorize the doctors of Arlington Cat Clinic, Ltd. and their support staff, to administer such treatment and /or perform such diagnostic or surgical procedures as deemed necessary. It is understood that an estimate of charges will be given for hospitalizations and surgeries. No guarantee or assurance can be made as to the results that may be obtained. Further, I realize that these charges may exceed a given estimate if complications arise. I understand that I will be contacted prior to treatment, if possible. I agree to pay Arlington Cat Clinic, Ltd. at the time services are rendered. If the account goes delinquent; no payment in 30 days, the account will be assessed a 2.00% billing fee on the outstanding balance (24% yearly). I further agree if the account is transferred to collections, I will be responsible for all the costs necessary to collect this balance including collection fees, costs, and filing fees. If a check is returned non-sufficient funds, a minimum of $25.00 will be added to the amount owed.

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    This appointment is set just for your pet. Because appointments are valuable to our pets and clients, we do respectfully ask for 24 hour notice for cancellations. Repeated rescheduled appointments, cancellations, or no-shows, will be assessed a fee. We appreciate your courtesy and understanding.
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