I left my long-time vet for some of that reason -- the bill would come with TONS of add ons like special food, shampoo, fecal, full blood panel, treats, toys, dental chews, flea/tick, etc. Then you would have to initial each to "deny the charge". Then they would come back with the real bill for what you had done. Fabulous vet but the economy decimated her clientele and she had to peddle stuff to make the bills. Had to find a new vet whose worst vice is trying to get yearly shots for everything (once I whispered I do the three year protocol) they kind of don't ask.