Disclosure Statement Salem Animal Hospital will maintain the following operating business hours:Monday - Thursday: 7:30am – 8:00pm Friday: 7:30am – 7:00pm Saturday: 8:00am – 2:00pm Sunday: ClosedWe are required to make our clients aware of the hours of operation of Salem Animal Hospital. Salem Animal Hospital is open during the hours listed above. We are closed all major holidays. Please be advised that although certain staff may remain in clinic several hours after closing time; we do NOT have overnight care. Twenty-four (24) hour medical care is not provided at this facility. There is NO in-house, on-duty, continuous medical staffing care available during nonoperating hours. Should an animal require care or monitoring during non-staffed hours, the client will be contacted, and arrangements made to transport the pet to an emergency or 24-hour care facility. Transportation and emergency service fees are the responsibility of the client.I have read and understand the above information and am aware of the staffing hours. By signing below, I agree that I have read and understand the above Disclosure Statement.PAYMENT IS DUE IN FULL AT THE TIME SERVICE RENDERED. For your convenience we accept cash, checks, Visa, MasterCard and Care Credit (which can be approved in as little as 10 minutes). If there are any billing questions, please address them with the office staff prior to the visit so that we can most effectively address your concerns.I hereby assume financial responsibility for all professional services rendered, anesthetics, pharmaceuticals, hospitals fees and costs incurred for procedures performed on my pet(s). In the event this account becomes delinquent, it will be turned over to an attorney for collection and I agree to pay all additional costs and additional attorney’s fees associated with the collection. I understand that payment is required at the time service is rendered. I agree that in the case of nonpayment, a fee of 1.5% per month (18% per annum) and a billing fee may be charged. All collection and attorney fees necessary to collect this debt will be borne by me. To my knowledge, all the above information is correct. By signing below, I agree that I have read and understand the above information and assume full financial responsibility. SIGNATURE REQUIRED*Print Name* First Last Date* Date Format: MM slash DD slash YYYY Photo ReleaseSalem Animal Hospital has my permission to use my photograph/image or my pets’ photograph/images publicly to promote the hospital. I understand the images may be used in print publications, online publications, websites, or social media. I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use. SIGNATUREDate Date Format: MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
