Treatment Consent

Please fill out our consent form before your visit.

Consent Form

We look forward to seeing you soon! Please Note: Any field marked with * is required.
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I hereby authorize the following people to present my pet(s) for treatment in my absence should an injury or illness occur to my pet(s) that requires veterinary care. I will provide the following people with a payment method (cash, check, or credit card) to pay the bill at the time of service. *

Print Name

This authorization also includes any medical treatments, anesthesia consents, or surgical procedures needed (and any charges with fees incurred for the above). The total amount should not exceed ($):

I authorize any veterinarian to provide my pet with veterinary care and essential medical service. *

I authorize

In the event that the attending veterinarian determines that my pet is suffering and/or is incurably injured, do you consent to euthanasia? Please understand that if your pet's health is this critical, we will try everything in our power to get in contact with you before any decisions are made. *

I will be able to be reached at the following phone number: *

Pet Caretaker #1 *

First

Last

Phone *

Email *

Pet Caretaker #2

First

Last

Email *

Phone

Date *

Treatment Consent

Consent Form

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