WELCOME to the ANIMAL EYE CARE CENTER, LLC ‘A Site for Sore Eyes’

Click here to print hard copy to bring to the office or fill out the online form on this page.

Name of your veterinarian
Hospital Name and Phone Number
How did you hear about us?
I Agree to Terms & Conditions *
Agree
Terms & Conditions ASSUME FULL FINANCIAL RESPONSIBILITY FOR ALL CHARGES INCURRED TO THIS PATIENT. PAYMENT FOR SERVICES IS DUE IN ITS ENTIRETY AT THE TIME THAT SERVICES ARE PROVIDED. IF A CHECK IS RETURNED, THE OWNER AGREES TO PAY A $25.00 PROCESSING FEE. IF FOR ANY REASON THE CHARGES ARE NOT PAID IN FULL AT THE TIME OF THE PET'S RELEASE, I WILL BE RESPONSIBLE NOT ONLY FOR THE BALANCE DUE, BUT FOR A $10.00 MONTHLY BILLING FEE. AS WELL AS FOR ANY COLLECTION AND/OR REASONABLE ATTORNEY FEES THAT ARE INCURRED IN THE ATTEMPT TO COLLECT THIS DEBT.

** IF YOU DO NOT SHOW AND DO NOT CALL TO CANCEL/RESCHEDULE AN APPOINTMENT. YOU WILL BE REQUIRED TO PRE-PAY FOR THE NEXT EXAM. REFUNDABLE ONLY IF EXAM IS CANCELLED/RESCHEDULED AT LEAST 24HOURS BEFORE APPOINTMENT TIME.

Serving the Maryland and DC Area for 20 Years
Address: 9043 Gaither Road, Gaithersburg,
MD 20877 Telephone: 301.990.6373
Fax: 301.560.6588