Free · Unbranded · Consent & legal
A one-page agreement for clients paying a balance over time. It writes down the total, the down payment, each installment date, and what happens if a payment is missed, so both sides have the same numbers.
Unbranded: no logo or linksNo account neededPrint at 100% on US LetterUpdated
What’s on the form
Client contact details, the patient, invoice numbers, and the services the balance covers.
Total balance, down payment, amount financed, number of payments, payment amount, frequency, and any fee your practice charges.
Card on file, automatic charge, cash, or check, and the date each payment is due.
Ten installment lines with due date, amount, date paid, and staff initials.
Missed payment terms written by your practice, then client and practice signatures.
Fill in online
Every line on the form is editable right here. When you’re done, print it or choose “Save as PDF” in the print dialog. Everything stays in your browser.
Click any line to type, or add your logo. Nothing is uploaded or saved.
Using it well
Late fees, interest, and collections are regulated differently in each state. Fill in the terms your attorney approved rather than inventing them at the desk.
A meaningful first payment on the day of service is one of the strongest predictors that the rest will be paid.
Logging each payment on the schedule gives the client and the practice the same view of what is left.
Printing, editing, and what the form does and doesn’t cover.
Many practices do, on their own terms or through third-party financing. If you charge interest or fees, state and federal lending rules may apply, so have your attorney review the terms.
The total balance, down payment, amount and frequency of payments, due dates, payment method, what happens if a payment is missed, and signatures from both the client and the practice.
It has blank fields for them. Whether you can charge them, and how much, depends on your state, so the wording is left for your practice to fill in.
It is a starting template, not legal advice. Have your practice’s attorney review it before use.
1 page, US Letter, portrait
A one-page itemized estimate with low and high columns, totals, deposit, and an expiry date. Clients choose accept, decline, or a partial plan and sign, so the decision and the numbers are on the record together.
2 pages, US Letter, portrait
A clean intake form for new clients: owner and emergency contacts, room for two pets, the previous clinic and a records-transfer authorization, reminder preferences, and the payment acknowledgment, all in one pass at the front desk.
1 page, US Letter, portrait
A one-page close-out for the front desk: count the drawer, total each payment type, compare it with your practice software’s daily report, and explain any difference before anyone goes home.
A starting point, not legal or clinical advice. VetStack’s forms are general templates. Requirements for medical records, consent, and controlled substances vary by state and practice, so review the wording with your practice’s attorney and check your state veterinary board’s rules before adopting a form as standard.