LET’S GET ACQUAINTED

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I don't have an e-mail or prefer not to give it out

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For vaccine reminders, newsletters, and special event notices. We will never give your email address to any third party.

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Physical Address: (IF DIFFERENT)

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Spouse Name:

SPOUSE NAME

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Agreement

In signing I understand that I am responsible for all fees incurred at Bannock Animal Medical Center, and that I am the owner, or representative of the owner, for each pet listed. I give permission to Bannock Animal Medical Center to transmit my pets’ entire medical records to other veterinarians who have given my pet care, or to whom I may take my pet in the future for care, upon their verbal request. I understand that should collection become necessary, as the responsible party, I agree to pay an additional $100 collection fee and all legal fees associated with the collection process, with and without suit, including attorneys’ fees and court costs.

I agree to terms

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Submit

LET’S GET ACQUAINTED

LET’S GET ACQUAINTED

For vaccine reminders, newsletters, and special event notices. We will never give your email address to any third party.

Agreement

Perfered Payment

CARECREDIT

We regret that we are unable to accept checks.