Welcome To Lakeside Animal Hospital


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

Info@Lakeside.vet

Client Information


Employer Information


Emergency Contact Information




Pet Information







Payment

(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%.

April 20, 2021

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Signature Certificate
Document name: Welcome To Lakeside Animal Hospital
lock iconUnique Document ID: 9dbfa057a81bf45e70af61e016ba7a02d90ff352
Timestamp Audit
January 8, 2021 6:52 pm EDTWelcome To Lakeside Animal Hospital Uploaded by Sherry Burgess - christina@jonroc.com IP 73.55.191.4
January 13, 2021 12:37 pm EDT Document owner christina@jonroc.com has handed over this document to manager@lakeside.vet 2021-01-13 12:37:40 - 73.55.191.4