Drop Off/Day Admission Consent

I verify that I am the owner (or authorized agent for the owner) of the above-named pet and authorize the following: *

Examination
Any diagnostic tests or treatments that are deemed neccessary
Do not proceed with any testing without contacting me before hand
Other

If I cannot be reached: *

I only authorize an examination, do not proceed with any testing or treatments
I authorize the doctor to proceed with any diagnositic testing and/or treatments deemed necessary
Other

In the event of an unforeseen emergency, we will attempt to reach you without delay. Please know that we will take every precaution to ensure that your pet is safe and healthy enough to undergo their procedures today. Any known risks will be discussed with you. However, very rarely emergencies do happen, and we want to know your preference if no one can be reached. Please check your preference: *

Please DO proceed with life-saving measures. I will accept all responsibility for all costs incurred.
Please DO NOT proceed with life-saving measures. I accept responsibility for all costs incurred.

I am aware that due to possible unforeseen emergencies, patients will be triaged resulting in my pet being in the care of Central Animal Hospital until later in the day than expected. *

I agree to be responsible for all charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. In the unlikely event my pet may need to stay overnight I understand no staff will be attending to my pet between the hours of 10 pm and 6 am (pets needing special care may be referred to a 24 hour hospital). *

Drop Off/Day Admission Consent

OWNER INFORMATION

PET INFORMATION

ACKNOWLEDGMENTS