Patient Drop-Off Consent Form

Complete your Patient Drop-Off Consent Form online before your visit to save time during your next appointment!

Patient Drop-Off Consent Form

To help us get to know you and your pets, please fill out this form completely and accurately!

As the owner, or duly authorized agent of the owner, of the above-named animal, I hereby consent to authorize the clinic to receive, prescribe, or treat the above-named animal. The staff is to use all reasonable precautions against injury, escape, or demise, but the staff will not be held liable or responsible in any manner regarding the care, treatment, or safekeeping of the animal. I understand that I am assuming all risks involved in the care and treatment of this animal. I consent to the administration of anesthesia as deemed necessary by the doctor.

While I accept that all procedures will be performed to the best of the abilities of the veterinarians and staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I agree to assume financial responsibility for the remaining fees and provide payment credit card, or check at the time my pet is discharged from the hospital. Additionally, please note there will be an automatic exam fee and a drop-off fee.

Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, the staff has my permission to provide such treatment. I hereby agree to pay for such services. I understand that, during the performance of medical, surgical, or anesthetic procedures, unforeseen conditions may be revealed that necessitate more extensive, costly, or different procedures than originally planned. If the staff at this veterinary practice is unable to reach me, I hereby consent to authorize the performance of such procedures when they are necessary and desirable according to the professional judgment of the attending veterinarian.

By signing this form, I acknowledge that I am the owner or authorized representative, and I am the one who can make medical decisions for the above-said pet.

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