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If you need to have another clinic or practice submit records to us, they may fax them to 239-945-4746. If they wish to email them, they may send the records to email@example.com
Treatment Plan Cost of Care
The cost of care will be communicated to you through a treatment plan as determined by your doctor, and constitutes informed consent. We ask that for any cases involving hospitalization, you provide us with one central point of contact, and one phone number that would be best to contact for discussion and case updates. This will help streamline communication between you and our hospital, and help alleviate any potential stress that can result from hospital stays.
Outpatient fees are due in full at the time of discharge, and for inpatient cases (hospitalized pets or pets boarding with us), we ask for 50% of the total at the time of admission, and payment of balance in full at the time of discharge. Chiquita Animal Hospital accepts payment in the form of cash, check (following 4 visits to the practice to establish a professional relationship with us), Mastercard, Visa, Discover, Debit card, CareCredit, and Chiquita Animal Hospital gift cards. We do suggest all clients consider pet insurance policies as a means to help defray and cover the cost of care, especially those of an urgent nature. Our staff can provide you with brochures for VPI (Veterinary Pet Insurance), and Trupanion Pet Insurance, both of which are conveniently located in our waiting area.
Authorization of Treatment
Signing of this form constitutes authorization for treatment (medical, surgical, and/or emergency) of the pet(s) you are presenting, and you agree to accept any financial responsibility for the cost of care afforded to those pets, regardless whether you are the pet’s owner, or a 3rd party authorized representative. Chiquita Animal Hospital considers the party presenting the pet for treatment as the party who is financially responsible for any care agreed upon and administered. There may also be additional charges associated with rechecks, office visits, radiographs, etc, not included in the initial treatment plan which you will be accountable for in terms of payment.
Responsibility for Payment
I have read the above statements and acknowledge the information I have provided to be accurate and truthful. I have also read the provisions above as related to services rendered and payment for such services.