Welcome To Lakeside Animal Hospital


Marissa Gonzalez,
DVM Dawn Lenihan,
DVM Kim-Vi Sweetman, BVetMed

Info@Lakeside.vet

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Client Information

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Employer Information

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Emergency Contact Information

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Pet Information

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Payment

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(payment in full due at time of service)

Authorization

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of the animal. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. In the event this account is turned over for collection, I also agree to be responsible for attorney’s fees in the amount of 33 and 1/3% (percent) of the outstanding balance. I understand interest will accrue for any balance over 30 days at a rate of 1.5%.

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Signature Certificate
Document name: Welcome To Lakeside Animal Hospital
lock iconUnique Document ID: 8b696d0b80376e7d2dbc273ba0da23559b489f14
Timestamp Audit
January 8, 2021 6:52 pm ESTWelcome To Lakeside Animal Hospital Uploaded by Sherry Burgess - manager@lakeside.vet IP 71.251.236.64
January 13, 2021 12:37 pm EST Document owner christina@jonroc.com has handed over this document to manager@lakeside.vet 2021-01-13 12:37:40 - 73.55.191.4