Urgent Care New Client Form

1. You may choose to pay by cash or credit/debit card (Visa, Mastercard, American Express, or Discover). We also accept payments through CareCredit. You can apply for a CareCredit account at www.carecredit.com or by calling 1-800-365-8295. You can also apply here at our office. We accept checks from established clients only and we reserve the right to refuse a check at any time for any reason. Checks not payable by the bank are forwarded to CheckNet in Wichita Falls, TX. A fee of $30 plus applicable taxes is charged by CheckNet for each returned check. In the event that you have a balance on your account, you will receive a monthly statement. We reserve the right to impose a $5 billing fee on an account each time a statement is mailed. The full balance on your statement is due and payable when the statement is issued and is past due if not paid by the due date displayed on the statement.

2. If your account becomes past due, we will take necessary steps to collect this debt. If we have to refer your account to a collections agency, you agree to pay all of the collection costs which are incurred. If we have to refer collection of the balance to a lawyer, you agree to pay all lawyers' fees which we incur plus all court costs. In case of suit, you agree the venue shall be in Randall County, TX.

4. Due to Texas state law, all pharmaceutical and nutraceutical sales are final.

5. The veterinarians at Swann Animal Clinic may use some medications in an extra-label manner in accordance with The Animal Medicinal Drug Use Clarification Act of 1994. Examples of extra-label drug use include: use in another species, use for a different indication, use at a different dose or frequency, and use via a different route of administration. If you have any questions regarding extra-label drug use, please consult with your veterinarian.

6. By checking the box below, you are agreeing to all the policies above and that you are responsible for all fees incurred. This includes any medication and diagnostic procedures. The responsibility continues in the event that the patient fails to recover or is euthanized. I hereby authorize the veterinarian to examine, prescribe for, or treat the above pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that charges will be paid at the time of release and that a deposit may be required for surgical or extensive medical treatment.