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  • Pet's NameBreedColorBirthday/Age 
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  • Canine / FelineSexSpayed / NeuteredCurrent on Rabies vaccine? 
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  • Initial, indicating approval
  • I understand that payment is due at the time services are rendered. Payment may be made in the form of cash, check, Care Credit, and all major credit cards. I am aware there will be a penalty, up to the maximum allowed by law, for a check returned for any reason. I am responsible for all reasonable debt, expense, service charges and fees, including financial, legal, and by collection services/agencies, necessary in the collection of unpaid debt to AVDS. I further authorize AVDS and its financial institutions and agents to retrieve these funds.



    I have read, understood, and verify all information provided by me above.

  • MM slash DD slash YYYY