Estimate Approval Form

I acknowledge receipt of the estimate referred to above, which is valid for 30 days. I agree to pay for the listed charges, but I understand they reflect an estimate only and that actual charges may differ depending on my pet’s medical needs and response to treatment. VMC Fort Mill agrees to make every reasonable effort to stay within the fees set forth in this estimate and to contact me should additional charges be deemed necessary.

I have read and do understand this estimate. I understand that I am legally responsible for the amount listed when services are performed. Procedure/Hospitalization estimates require a 50% deposit upon admission and payment in full is due when the patient is discharged from the hospital.