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Pet Owner Information
Name*
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Middle Initial
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Spouse Name:
First
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Driver's License #
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Address*
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Email*
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Employer Information
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Emergency Contact
Name*
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Address*
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Phone*
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Pet Information
Pet's Name*
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Dog or Cat?*
*
Dog
Cat
Breed*
*
Color*
*
Date of Birth/Approximate Age*
*
Gender
Male
Female
Spayed/Neutered?
No
Yes
Are They Microchipped?
Yes
No
On Heartworm Preventative?
Yes
No
On Flea/Tick Preventative?
Yes
No
Microchip #
Have More Pets to Add?
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No
Yes
Second Pet Information
Pet's Name*
*
Dog or Cat?*
*
Dog
Cat
Breed*
*
Color*
*
Date of Birth/Approximate Age*
*
Gender
Male
Female
Spayed/Neutered?
No
Yes
Are They Microchipped?
Yes
No
On Heartworm Preventative?
Yes
No
On Flea/Tick Preventative?
Yes
No
Microchip #
Have a Third Pet to Add?
*
No
Yes
Third Pet Information
Pet's Name*
*
Dog or Cat?*
*
Dog
Cat
Breed*
*
Color*
*
Date of Birth/Approximate Age*
*
Gender
Male
Female
Spayed/Neutered?
No
Yes
Are They Microchipped?
Yes
No
On Heartworm Preventative?
Yes
No
On Flea/Tick Preventative?
Yes
No
Microchip #
Thank You for Choosing Us!
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Whom May We Thank?
Financial Policy
Thank you for choosing YUKON VETERINARY HOSPITAL. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet.
An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options.
You can choose from:
- Cash, Check, Visa®, American Express®, MasterCard® or Discover Card®
- Convenient Monthly Payment Plans* from CareCredit®
- Allow you to begin treatment today and pay CareCredit over time
- Available for any treatment amount
- Can be used repeatedly without having to reapply
We do not offer any in-house payment plans. We charge 1.5% interest on all outstanding balances older than 30 days. If you have an account 90 days past due, YUKON VETERINARY HOSPITAL will relinquish your balance owed to a collection agency.
By signing below, you give permission to YUKON VETERINARY HOSPITAL and its agents to contact you on any phone number/email that has been provided, including cell phone and emergency contacts, for the purpose of collecting a debt.
YUKON VETERINARY HOSPITALequires payment the day services are rendered, or at the time of patient discharge. For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier.
There is a fee of $27.50 for all returned checks.
If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available to your pet.
By signing below, you agree to the aforementioned terms of payment:
Owner's Electronic Signature*
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