New Patient Form

New Patient Form

    Client Information

    Pet #1

    DogCat

    Pet #2

    DogCat

    Pet #3

    DogCat

    I understand that any unpaid bill past 30 days will be subject to an 18% interest charge. I will also be responsible for an additional 50% collection fee if a collection service is required

    Authorization For Treatment

    I authorize and direct Compassion Animal Hospital, Dr. Cooper, or his associate, to treat the above-mentioned animal or any additional animals I own. I UNDERSTAND THAT FEES WILL BE PAID IN FULL AT THE TIME SERVICES ARE RENDERED.

    [signature* signature-267 class:sig_class]