2331 Colony Crossing PlaceMidlothian, VA 23112
A commitment to provide qualityveterinary care for your loved ones.
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Patient Name
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I hereby authorize the veterinarian to examine, prescribe, and provide medical care of the patients described above. I certify that I am 18 years of age or older and the information given above to be accurate. I understand payment is expected at the time services are rendered, and that any unpaid balance is subject to 18% APR and a minimum finance charge of $5.00 per month.
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Thank you for contacting us. Your information has been received. We look forward to your visit.
