Consent Form

I, the undersigned owner, the authorized agent of the owner, or the Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am over eighteen (18) years of age, and I hereby consent to the examination of this pet by staff veterinarians at Pine Castle Animal Care Center.

I understand that, in addition to the physical examination of my pet, blood and urine tests, radiographs (X-rays), and other diagnostic tests may be necessary to determine the cause of my pet’s medical condition and the best course of treatment. I understand I must give my consent for each test that is performed before any test can be performed, as required by Florida Law. If I have any questions or concerns about my pet’s care, I will discuss them thoroughly with the veterinary staff of PCACC.

I understand that the practice of medicine is not an exact science. The treatment of any patient may change depending upon the evolving nature of the condition and the response of the patient to treatment. Complications can arise, and prognoses may change. I am encouraged to discuss all questions concerning my pet’s health with my veterinarian at all times.

I understand that vaccinations protect my pet and family from serious diseases, and I also understand that vaccine administrations are not without total risk. While vaccine reactions are rare and generally mild if they occur, they include but are not limited to lethargy, hives, swelling, nodule formation, tenderness, infection at the injection site, and gastrointestinal upset. I understand I should seek medical care if I suspect an adverse reaction is at play.

If my pet is hospitalized overnight, I understand that continuous veterinary care during nighttime hours is not guaranteed. If I desire my pet to have continuous overnight care, I will transfer my pet to the Veterinary Emergency Clinic of Central Florida (VEC) or another facility where continuous veterinary supervision is available.

I understand that an estimate of the costs for veterinary services will be provided to me upon my request, and I understand that I am encouraged to discuss all fees attendant during the ongoing care of my pet. I agree to assume full financial responsibility and pay for the balance of all services rendered at the time of patient discharge. I agree to pay a fee of $35.00 for any check that is returned due to insufficient funds and a monthly processing fee of $25.00 should a billing statement be generated.

If my address or phone number(s) change, or if a change of patient ownership occurs, I will notify PCACC of such change so continuous communications concerning this patient’s health can be maintained.

I acknowledge that no guarantee of successful treatment has been made to me. I hereby release and discharge PCACC, its doctors, and its staff from all claims and demands I have or may have against PCACC, its doctors, and its staff by reason of any medical, surgical, diagnostic procedure, deficiency thereof, adverse drug reaction, or performance of other services as they relate to this patient.

I hereby state that I have read and understand this agreement, and I am in agreement with the policies set forth. This agreement will be binding for the duration I own this patient.