Credit Card Payment Form

APPOINTMENT

Please complete this form before your visit.

Thank you for allowing us to care for your pet.

 
  • When admitting any patient into our center we do require that a form of payment is left with us at the time of your admission.
  • Please select the form of payment you will be utilizing today and understand that all payments are due in full at the time of services rendered.
  • We DO NOT accept checks as a form of payment for services.
  • Due to COVID-19, we are not accepting cash at this time.
  • Please sign the method of payment form before leaving your pet.
 

Thank you for your understanding.

Credit Card Release and Cancellation Policy

There is no personal billing for Dr. DeForge's professional services.

 

All payments for Dr. DeForge's professional fees are through the Connecticut office at the Silver Sands Veterinary. Dr. DeForge does not accept cash or check payments at the satellite offices for his professional fees. Professional fees will be billed to the credit card that you name above after services are rendered. Credit card information is confidential and will only be utilized at the satellite offices.

 

This credit card authorization form must be completed prior to your scheduled appointment at either satellite office. After this release is received by the office, your appointment is considered verified.

 

I have read the above statement and understand the policy.