Please read and sign the following authorization for treatment:
I am 19 years of age or older, and I hereby authorize the staff of Culbreth Carr Watson Animal Clinic to render any treatment which is deemed necessary while in custody of the clinic.
I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me, or my designated representative, before proceeding with treatment.
I understand that I will be financially responsible for all procedures and costs, including any estimate of charges for treatment provided to me in person or over the telephone. Payment is due at the time services are rendered. A $30.00 returned check fee will be charged for all returned checks. I understand that if at any time there is an unpaid balance on my account, there will be an additional 33.33% collection agency fee and my account will be placed with a collection agency, which will appear on my credit report, and that I will be held responsible for attorney fees and court costs if such be necessary.
I give Culbreth Carr Watson Animal Clinic and/or our agents, to contact you by telephone at any phone number associated with your account, including wireless phone numbers, which may result in charges to you. Methods of contact may include use of auto dialing equipment and/or pre-recorded artificial voice messaging, text messaging or email.