48-18 Vernon Blvd. Long Island City, NY 11101

Phone: (718) 383-VETS   Fax: (718) 255-6514

Open 7 Days a Week   Mon-Fri: 8-7   Sat: 8-2   Sun: 9-3

  • Keith Manning, DVM
    Director

Welcome!

  • Thank you for giving us the opportunity to care for your pet. In order for us to become acquainted, please fill out the following:


Pet Information


Agreement & Signature

  • We kindly request that all services are paid for at the time they are provided. I understand there will be a twenty-five dollar fee for all returned checks and I agree to pay a monthly, compounded interest rate of 1.25% on all unpaid balances. In the event of an emergency and I am not able to be reached, I authorize and agree to pay for any service Long Island City Veterinary Center determines is necessary to provide the highest standard of care to my pet. I acknowledge that I am the owner of the patient listed above or that I am authorized by the owner to make medical decisions on its behalf. In cases where the rightful owner fails to make payments for any medical decisions made, I will assume the financial responsibility for the decisions I have made. I attest that I am at least 18 years of age.

Verification

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