Procedure Consent Form

As the owner or duly authorized agent of the owner of the above-named animal, I hereby consent to and authorize the clinic to receive, prescribe, or perform medical or surgical procedures on this animal as indicated below.

REQUIREMENTS FOR ADMISSION:

Parasite treatment (internal and/or external) at the owner's expense.

Our office is to use all reasonable precautions against injury, escape, or demise, but will not be held liable or responsible in any manner regarding the care, treatment, or safekeeping of the animal. I understand that I am assuming all risks involved in care and treatment for this animal. I consent to the administration of anesthesia as deemed necessary by the doctor. I acknowledge that risks and the possibility of complications exist in any surgical or medical treatment. By signing, I give consent for the doctor to perform additional procedures necessary during the procedure.

An estimate of anticipated fees has or can be given to me upon request. A deposit may be required upon admittance to the clinic. All charges shall be paid in full at the time of release.

All animals must be picked up within the time frame specified in the follow-up call or message. A written notice will be mailed to the address above if the owner or authorized agent fails to pick up the animal. Five (5) days after such written notice, the animal will be considered abandoned and its care left to the discretion of the clinic. It is understood that abandonment does not relieve me from the responsibility of payment for services rendered, including the cost of boarding.

I agree that in the case of nonpayment, a fee of 1.5% per month (18% per annum) will be charged. All collection and attorney fees necessary to collect this debt will be borne by me.

Client signature designates agreement with above information.