Patient Registration Form

I, the undersigned owner or authorized agent of the above admitted patient, hereby authorize the doctors of Mission Vet Urgent Care to administer such treatment as is necessary and to perform procedures therapeutically and/ or diagnostically. I further understand that no guarantee of successful treatment is made. I assume financial responsibility for all charges uncured and agree to pay all such charges at the time of release.

**PAYMENT IS DUE AT THE TIME SERVICES ARE RENDERED** in the event of non-payment for any reason a third-party collections agency will attempt to collect this amount including an additional 25% fee for this service.

We accept cash, all major credit cards, and Scratch Pay/ Care Credit.