Veterinary Services Payment Plan Agreement
Client Information
Client Name:
Address:
Phone Number:
Email:
Pet Information
Pet Name:
Species/Breed:
Clinic Information
Clinic Name:
Veterinarian:
Payment Plan Details
Total Amount Due:
Down Payment:
Remaining Balance:
Number of Payments:
Payment Amount:
Payment Due Dates:
Accepted Payment Methods:
Terms and Conditions
Client agrees to pay the total amount due as outlined above according to the agreed-upon schedule.
Payments not made by the due date may be subject to late fees.
If any payment is missed, the remaining balance may become due immediately.
Services provided under this agreement are subject to the clinic's policies.
Failure to comply with this agreement may result in suspension of further services until the account is brought up to date.
Additional Notes
Client Signature
Date
Clinic Representative Signature
Date