Aldie Veterinary Hospital
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Emergency Treatment Authorization

  • has been admitted to Dulles South Veterinary Center. To more effectively and swiftly assist your pet, we require authorization to initiate and/or continue treatments if needed to stabilize your pet. By signing this form, you are accepting financial responsibility for these treatments, including an emergency exam fee. The doctor will speak to you as soon as reasonably possible in a most-to-least critical state order of arrival and will provide you with a medical care plan (an estimate of the total expected charges, including emergency treatments).

    A deposit of the low end of the estimate is required at this time to continue treatments and will be applied to the total costs. Dulles South Veterinary Center accepts Visa, MasterCard, American Express, Discover, cash, Care Credit and Scratch Pay. WE DO NOT OFFER ANY PAYMENT PLANS.