Step 1 of 2

  • Owner

  • Treatment Authorization and Release (of pet(s) listed on page 2)

  • 1. To my knowledge the animal listed above is in good health. I acknowledge the fact that all pre-and post-operative care is my responsibility. I am the owner and responsible party of the pet(s) listed and have the authority to execute this consent.

    2. I understand that if my pet is aggressive and requires extra medication, time, or staff there may be an extra charge.

    3. I understand that if my animal is undergoing surgery and is found to have fleas that they will be treated with a flea adulticide at my expense.

    4. I hereby also authorize the use of such anesthetics and vaccinations as you deem advisable and the performance of such surgical and therapeutic procedures as you determine necessary. I understand that some risks always exist with anesthesia and/or surgery, vaccination, and treatments and that I am encouraged to discuss any concerns I may have about those risks with the attending veterinarian before the procedures are initiated. My signature on this form indicates that any questions I have regarding these issues have been answered to my satisfaction.

    5. I agree to indemnify and hold harmless Spay Neuter Clinic and the attending veterinarian from and against all liability arising out of the performance of all procedures referred to above.

    6. I understand that trained personnel will NOT attend hospitalized animals beyond the regular office hours.

  • PAYMENT OF YOUR BILL IS DUE IN FULL AT THE TIME THE ANIMAL IS TREATED

    I confirm that all of the information on this form is accurate and true to the best of my knowledge.
  • Date Format: MM slash DD slash YYYY