Owner Consent for Treatment

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  • Owner Information

  • Patient Information

  • Financial Information

    Payment in full is required at the completion of services. Final payment may be made by credit card, cash or check. Please note all returned checks will be charged a $35 fee. If the account is NOT paid in full at the completion of services, and after you review of the final bill, the amount due will be charged to your credit card.
  • There is a cancellation fee for no shows and appointments that cancel with less than 24hrs notice.
  • Client Authorization

  • Patient Insurance

  • The insurance carrier for animals is handled differently than the medical insurance carried for yourself. We are not reimbursed by the insurance companies for services rendered. Cave Creek Equine will be happy to assist in completing the required insurance paperwork for your reimbursement once the account has been paid in full.

    Discharge: If you are not present at the time of discharge, your completed invoice will be faxed or mailed to you and payment will be charged to the credit card you have indicated on your admission form. A copy of the receipt and your final bill will be mailed to you.

  • Submission

  • (if you are printing this form)