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Owner Information (Person Responsible For Payment And Under Whose Name The Cat Will Be Registered)*
Residence Address*
Type
Type
Work Address
Spouse/other Name
Type
Type
Work Address
Emergency Contact (Other Than Yourself)
How were you referred to our clinic?

WE ACCEPT VISA, MASTERCARD, DISCOVER, AND AMERICAN EXPRESS.

SORRY NO CHECKS ACCEPTED

By signing today, I authorize the veterinarian to examine, prescribe for, and treat my pet and understand that payment is expected at the time of service or that a deposit is required for surgical treatment. As well, I also know that Cat Care of Vinings accepts Cash and Credit Cards for my convenience. I acknowledge that Cat Care of Vinings does require I bring my cat in a pet-safe carrier/kennel for the safety of my animal. I understand that if I do not bring my cat in a pet-safe carrier/kennel Cat Care of Vinings will add a cardboard temporary carrier to my invoice for my cat to go home in.
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This field is for validation purposes and should be left unchanged.