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I/we accept and acknowledge that payment is due at the time service or at the time of discharge from the hospital.

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I/we accept that if I fail to show up for scheduled appointments, I will be asked to leave a non-refundable deposit prior to scheduling future appointments.

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I/we understand there is a $20.00 service fee charge for any returned check.

Initial

I/we understand that if I am more than 10 minutes late for my pet’s appointment, I/we may be required to reschedule. CVH will always attempt to accommodate late arrivals but in certain circumstances it may not be possible without creating significant delays for later appointments.

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Date

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Acknowledgement of Hospital Policies in Copake Falls

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Acknowledgement of Hospital Policies in Copake Falls

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