Testing Financial Policy Thank you for choosing North Alabama Animal Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of that mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. North Alabama Animal Hospital requires payment in full at the end of your pet's examination and/or at the time of discharge.Payment Options:You can choose from: Cash Check Visa® MasterCard® Discover Card® American Express®Convenient Monthly Payment Plans from CareCredit® (subject to credit approval) Allows you to begin treatment today and pay over time Available for any treatment amount Can be used repeatedly, for your entire family, without having to reapplyFor some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care of more than $500 or more, will require a 1/3 deposit to begin your pet's treatment. Additional Policy Information: North Alabama Animal Hospital charges $30 for returned checks. For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance provider. If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.By signing below, you agree to the terms of payment.Client/Owner SignatureDate Client/Owner Name (Please Print)Date Pet NameBreed Welcome Form Thank you for giving us the opportunity to care for your pet. To insure the best care possible, please take time to fill in this form completely. CLIENT INFORMATIONDate OwnerSSNDL#Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country DOB Home PhoneWork PhoneCell PhonePlace of EmploymentEmail Contact PreferenceEmailTextPhoneSpouseSSNWork PhoneCell PhoneEmergency Contact NamePhone NumbersAddress Street Address City State / Province / Region ZIP / Postal Code How did you hear about us?PET INFORMATIONNameCatDogOtherBreedColorBirth date/Ag MaleFemaleNeuteredSpayedMicrochip ID#NameCatDogOtherBreedColorMaleFemaleNeuteredSpayedBirth date/Ag Microchip ID#NameCatDogOtherBreedColorMaleFemaleNeuteredSpayedBirth date/Ag Microchip ID#AUTHORIZATIONI hereby authorize the veterinarian to examine, prescribe for, or treat my pet. I assume responsibility for all charges incurred during the care of my animals. I also understand that the charges will be paid at the time of release and that a deposit may be required for certain treatments. I understand that failure to comply will result in service and finance charges and as a last resort court cost and attorney fees.Signature of OwnerDate Method of PaymentCashCheckCredit/Debit CardCare Credit