Portland Veterinary Oncology Center

13655 SW Jenkins Road
Beaverton, OR 97005

(503)644-6581

portvetonc.com

New Client Fillable Form Form

Standard Consent & Client Information
Name
First Name
Last Name
Address
Street Address
City
,
State / Province
Zip / Postal Code
Phone
Phone TypePhone Number
Phone
Phone TypePhone Number
Appointment :
Date :
E-Mail Address :
Pet's Name

Species
Cat
Dog


Birth Date

Breed

Weight

Selection
Female
Spayed
Male
Neutered
Referring Doctor/Hospital

Preferred Pharmacy

Client Consent
I am the owner of the above pet, or am acting as an agent for the owner, and accept full financial responsibility. Payment is due as services are rendered. Portland Veterinary Oncology Center cannot extend credit. For patients requiring hospitalization, a deposit of 50% of the estimated cost is required in advance. The pet owner (or responsible agent) is financially responsible to Portland Veterinary Oncology Center for all applicable charges pertaining to this pets care.
I have read and agree to the above financial policy and I accept my financial obligations.

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