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Please Complete This Form Prior to Your First Visit

Guest Information

Pet Information

Payment is due when services are rendered. Highland Pet Hospital accepts cash, checks (with valid identification), Visa, MasterCard, American Express and Discover. Unfortunately, we are not able to extend credit, but we do accept Care Credit. We cannot accept post-dated checks.

By checking the "Agree" box, I certify that I am the owner of appointed agent of the above described animal(s) and agree to the financial terms stipulated herein, and that payment is required in full at the time of service.