CLIENT REGISTRATION FORM

1. I warrant that I am the owner of the patient, alternatively - I warrant that I have been duly authorised by the owener to request and pay for the services, I also acknowledge that if the owner disputes his authority or liability, that I will be personally liable.
2. Full payment is required at the time of consultation. We accept cash, debit and all major credit cards.
3. Should your pet be hospitalized we will request 50% of the cost-estimate on admission. The final and full balance is payable in full upon discharge, or on completion of treatment.
4. Fourways Vtereinary Hospital does not grant credit or run accounts.
5. It is expressly understood that I will be responsibe for any legal fees, collection charges and costs raised by an attorney and own client scale, tracing agents and persons other than lawyers.
6. I accept the residential address indicated above as domicillium citandi et executandi for the purposes of all correspondence.
7. I conscent to the jurisdiction of the Magistrate's Court for the purposes of all legal proceedings petaining to this account.
8. I irrevocably conscent to Fourways Veterinary Hospital making bona fide business enquiries with any credit burea regarding my financial affairs.
9. I irrevocably conscent to Fourways Veterinary Hospital reporting to any credit bureau my payment record pertaining to this agreement in the event that I am in breach of the agreement.



Fourways Veterinary Hospital and Specialist Referral Centre are committed to safeguarding your privacy and confidentiality of your personal information and are bound by the Protection of Personal Information Act, We andertake not to disclose or share your private information with any third party.

I ACCEPT THAT THE SERVICES ARE RENDERED SUBJECT TO THE CONDITIONS ABOVE, WHICH I ACKNOWLEDGE HAVE BEEN DRAWN TO MY ATTENTION AND THAT I HAVE READ AND UNDERSTAND THE SAME AND AGREE TO BE BOUND IN TERMS THEREOF.