REGISTRATION FORM

Please complete the below registration form before your first appointment. You can also download, print and complete the form by hand and bring it with you. Please email info@petsinbalance.co.za or call us on 021 852 3551 / 076 877 9558 if you have any questions.

Please note that we work on an appointment-only basis.

DOWNLOAD A CLIENT REGISTRATION FORM

PAYMENT AGREEMENT

WE DO NOT DO ACCOUNTS. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.

  1. I acknowledge that all accounts are payable in full upon presentation. WE DO NOT DO ACCOUNTS. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.
  2. I undertake to inquire as to the extent and approximate costs of a proposed treatment, failing which I unconditionally accept that I am liable for the costs thereof.
  3. I hereby render myself responsible for all costs, including interest at a rate of 2.5 % per month, for all telephone calls and time spent by the sta of this facility incurred in the recovery of the outstanding amount from time of presentation of the account.
  4. In the event that an account is handed over to your lawyers or other agent for collection, I irrevocably agree to pay for all costs on a lawyer and client scale, Legal Counsel on their agreed scale, collection commission, (including the costs and collection commission of any correspondent Attorney employed by your Attorneys or agent in connection therewith) and interest thereon at the rate of 1 % per month.
  5. I irrevocably consent to an attachment order being issued on my income against my current or future employers.
  6. I irrevocably consent to the jurisdiction of the court of choice of this facility and agree that all performance took place within the jurisdiction of these courts.
  7. I acknowledge that I have read these conditions and hold myself bound thereto.
  8. I hereby choose the Residential Address on page 1 for the service of all notices and court documents.