18577 Natchez AvenuePrior Lake, Minnesota, 55372
Cleary Lake Veterinary Hospital Equine
We will do our best to accommodate your busy schedule. Schedule an appointment today!
Please complete this form to request an appointment. Please note that you do not have an appointment until you receive confirmation from us. Thank you!
In the event of an emergency and I (and my spouse) cannot be reached (list names below) to make emergency appointments, I authorize order medication and treatments for my horse(s) on my behalf and I agree to pay for all veterinary expenses.
If no one is authorized by completing the lines above, I must authorize all work including emergencies.
1. This contract shall apply to any and all veterinary services provided by Cleary Lake Veterinary Hospital (CLVH), to any and all horses on my behalf, whether or not the horse(s) are listed on page one of this form.
2. I must give notice to cancel or reschedule an appointment 24 hours in advance. If I give less than 24 hours notice, I may be billed for charges associated with the services or supplies completed in preparation of the appointment.
3. If my check is returned for nonsufficient funds, I agree to pay the NSF fee of $30.
4. A 1.5% monthly finance charge (18% APR) or $3.00 statement fee, whichever is greater, will be applied on all balances on account not paid within 30 days.
5. If CLVH has not received payment in full within 60 days of invoice, CLVH reserves the right to immediately charge my credit card for the outstanding balance on my account.
After 90 days without payment, I understand that CLVH may refer my account to a collection agency or commence legal action if I fail to adhere to these Terms of Agreement.
7. CLVH has the right to refuse or suspend veterinary service for non-payment on my account.
By signing below, I acknowledge that I have read, understand, and agree to all of the above Terms of Agreement.
I hereby authorize Cleary Lake Veterinary Hospital to maintain my credit card information securely on file with a professional credit card processing service. In providing their office with my credit card information, I am giving Cleary Lake Veterinary Hospital permission to automatically charge my credit card on file for my outstanding balance/s, veterinary service/s and/or product/s as designated above. I agree to update any information (change in card number/security code, expiration date, billing address, etc) regarding this account.