I, the undersigned owner, authorized agent of the owner or Good Samaritan responsible for seeking veterinary care for the pet identified below, hereby consent to the examination of this pet by staff veterinarians at this veterinary practice. I also agree that after consultation, the hospital's doctors may prescribe medication for, treat, hospitalize, sedate, anesthetize and/or perform surgery on this animal. I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. Should some unexpected life-saving emergency care be required and the attending veterinarian is unable to reach me, the staff has my permission to provide such treatment and I agree to pay for all related fees.

I understand that an estimate of the costs for veterinary services will be provided to me, and that I am encouraged to discuss all fees corresponding to such care before services are rendered and during this pet's ongoing medical treatment. If this animal is hospitalized, I agree to pay a deposit for the estimated fees and assume financial responsibility for the balance of all services rendered on a cash, credit card or check basis at the time the pet is discharged from the hospital. In the event the pet is hospitalized for more than twenty-four hours and the attending doctor is unable to reach me, I understand it is my responsibility to call the hospital at least every twenty-four hours to inquire as to the medical status of my pet and the fees incurred for medical services up to that day. In the event of an open balance, I agree to make a monthly payment, including a financing fee equal to 1.5% of the unpaid balance.

I understand that veterinary care during night time hours and/or weekends is provided at the discretion of the attending veterinarian. Continuous presence of personnel may not be provided during these hours. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made.

I further agree that either I, or an authorized agent of mine, will pick up this pet and pay for all accrued charges within five days after receiving written or oral notification that this animal is ready to be released from the hospital. Such notice will be given at the address maintained on the hospital's patient/client record. I agree that if I fail to comply with this policy, this practice may handle this abandonment in the best interests of the pet and I will still be responsible for all fees incurred.


HAVE YOU TALKED WITH YOUR DOCTOR ABOUT THE FOLLOWING?
l. The medical and/or surgical treatment alternatives for your pet.
2. Sufficient details of the procedures for you to understand what will be performed.
3. How fully your pet might respond or recover and how long it could take.
4. The most common complications and how serious they might be.
5. The length and type of follow-up restraint and care required
6. How much this treatment is expected to cost and how payment will be handled.

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