Nurse admitting Name(Required) First Last Pet Name(Required)What is your pet here for today?(Required)I agree to pay all charges for services provided by Martinez Animal Hospital upon discharge of my pet. Payments can be made by most major credit cards, Care Credit or cash. A credit card processing fee of up to 3% will be applied to all transactions made using credit/debit cards.(Required) I UNDERSTANDI understand and accept the clinic's cancellation policy, which requires a minimum of 24 hours' notice for cancellations; otherwise, a cancellation fee may apply.(Required) I UNDERSTANDI acknowledge the clinic's late policy, which states that while efforts will be made to accommodate appointments, if I am more than 10 minutes late, Martinez Animal Hospital may not be able to provide services, and a $10 late fee may apply.(Required) I UNDERSTANDI understand that this appointment is scheduled with a nurse. If additional services are requested, a separate appointment may need to be scheduled with a doctor.(Required) I agree to the privacy policy.For inpatient appointments: If we find fleas on your pet during their hospitalization, we will administer CapStar flea treatment. You are responsible for the cost of treatment.(Required) I UNDERSTANDFor inpatient appointments: In order to treat your pet in a timely manner, it is extremely important that we are able to reach you by phone throughout the day. Please leave a number that will be answered and checked.Signature(Required)