Purpose: This is an agreement between Central Animal Hospital or Central Animal Hospital On Pinellas Point and the named person and responsible party on this form. We appreciate your choosing us for your pet health care needs, and we want to be sure you fully understand your financial obligations for the services we will be providing. By signing this agreement, you are agreeing to pay for all services rendered.
Payment Options if you have no pet insurance: Payment in full is due at time services are rendered.
You will be expected to pay by cash, VI/MC debit card, or other major credit cards on the day that treatment/services are rendered. We accept Master Card, Visa, American Express, and Discover. Payment by check is not accepted.
For extended rehabilitation, surgical, or other anesthetic procedures, a minimum of 50% deposit (cash or credit only) is due prior to the surgical or anesthetic procedure being performed. The balance is due at the time the patient is discharged.
For extensive treatment, you may prefer to secure third party financing (bank, credit union, etc.) for the entire amount and make payments to the lending institution.
We offer a special financing arrangement through Care Credit. Interest-free financing for 6 months is available if payment is made within the time period specified. For invoices above $1,000.00, Care Credit financing is available at a moderate interest rate.
Payment Options if you have Pet Insurance: We require payment in full due at the time services are rendered. We will provide you with an itemized statement to submit to your insurance company for reimbursement to you. We file Trupanion insurance at the time of the visit.
Monthly Statement: If you have a balance on your account, we will send you a monthly statement. It will show separately the previous balance, any new charges to the account, the finance charge and billing fees if any, and any payments or credits applied to your account during the month. If you have a credit balance, you have the right to retain the credit balance on your account for follow up visits or request reimbursement for the credit balance.
Finance Charge: A finance charge will be imposed on each item of your account which has not been paid within thirty (30) days of the time the item was added to the account. The finance charge will be computed at the rate of one percent (1%) per month or an ANNUAL FINANCE RATE of twelve (12%) percent. The finance charge on your account is computed by applying the periodic rate (1%) to the “overdue balance” of your account. The “overdue balance” of your account is calculated by taking the balance owed thirty (30) days ago and then subtracting any payments or credits applied to the account during that time.
Past due Accounts: If your account becomes past due (more than 30 days), we will take the necessary steps to collect this debt. If we have to refer your account to a collection agency, you agree to pay all of the collections costs which are 50% of the past due balance. If we have to refer collection of the balance to an attorney, you agree to pay all attorney’s fees which incur plus all court costs. In case of suit, you agree the venue shall be in Pinellas County, Florida.
Waiver of Confidentiality: You understand if this account is submitted to an attorney or collections agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that your pet received treatment at our office may become a matter of public record.