Fill Out Estimate Sign Off Form

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Client's Name:*

First Last

Client's Email*

For copy of this form for your records only.

Today's Date:*

Pet's Name:*

Date of Approval:*

As part of our effort to deliver outstanding veterinary care and service, we are providing you a detailed estimate for the best care of your best friend. Notice: This estimate is valid for 30 days. I agree to pay the above charges, I understand they reflect an estimate only, and that actual charges may differ depending on my pet's medical needs and response to treatment Tri-County Animal Hospital agrees to make every reasonable effort to stay within the fees set forth in this estimate and to contact me should additional charges be deemed necessary. If my pet is being admitted for hospitalization, I understand that Tri-County Animal Hospital does not have 24 hour care and pets will NOT be monitored overnight.

A deposit is required when leaving an animal in the hospital for treatment, regardless of anticipated length of stay. The remainder of the charges must be paid in full at the time my pet is discharged.

Deposit Amount: $*

Authorization Signature:*

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Fill Out Estimate Sign Off Form

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