Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Nolana Animal Hospital to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize the staff of Nolana Animal Hospital to render any treatment that is deemed necessary to my pets'health while in the custody of the hospital. 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, if time permits, proceeding with treatment. I understand that I will be financially responsible for all emergency procedures including Estimate of Charges provided to me in person or over the telephone. I understand that professional fees are to be paid at the time services are rendered and a deposit is required on all pets admitted to the hospital. I have been made aware that, if for any reason, I have an unpaid balance, Nolana Animal Hospital reserves the right to submit my balance to a third party collection agency with a 28% collection fee added and any applicable monthly interest charges of 0.005% of my balance.