THE SIGNER ON THIS ACCOUNT ACCEPTS FULL FINANCIAL RESPONSIBILITY FOR FOR ALL SERVICES RENDERED BY CHEYENNE WEST ANIMAL HOSPITAL ON ANY, OR ALL PETS LISTED ON THIS FILE. A 1.5% MONTHLY OR 18% ANNUAL INTEREST FEE WILL BE CHARGED ON ANY OUTSTANDING BALANCE AFTER 30 DAYS. SHOULD THIS ACCOUNT BE SENT TO COLLECTION, THE SIGNER WILL BE RESPONSIBLE FOR ANY SERVICE, COLLECTION, AND/OR LEGAL FEES. I ALSO UNDERSTAND CHEYENNE WEST ANIMAL HOSPITAL DOES NOT ACCEPT OUT-OF-STATE CHECKS OR THIRD PARTY CREDIT CARDS.
PLEASE NOTE: Cheyenne West Animal Hospital is not staffed 24 hours a day, and there may be times your pet is unsupervised. By signing this form I am acknowledging that a hospital staff member has explained to me that the hospital is not staffed with personnel overnight.