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Medical Drop-Off

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Client*

Patient*

Date*

As the owner of the above named pet, I hereby give my consent to Carpenter Animal Hospital to perform the following procedures:*

For all procedures:

All pets admitted to Carpenter Animal Hospital will have a physical examination performed to assess health and/or evaluate medical problems. Following this assessment, further diagnostic or treatment procedures may be recommended in addition to those listed above.

Please select one:*

I authorize further testing and treatment as needed at the doctor’s discretion.

I do not authorize additional diagnostics or procedures without first speaking to a member of the health care team. Please call me with an explanation and estimate for additional recommended procedures.

If an emergency situation arises and I cannot be contacted:

Please select one:*

I authorize the doctors at Carpenter Animal Hospital to treat my pet using their best judgment.

Carpenter Animal Hospital should not provide additional emergency treatment to my pet.

General Consent:

I have read and understand this authorization for medical care. I understand that some procedures come with inherent risks and complications may arise despite all efforts to prevent them. I have been informed of the risks and complications involved with my pet’s treatment and understand that results cannot be guaranteed. Furthermore I assume full financial responsibility for all charges for diagnostic and treatment procedures performed at Carpenter Animal Hospital. I agree to pay all charges at my pet’s discharge from the hospital. I understand that in the event of an emergency my pet will receive emergency care at my expense and the attending veterinarian will contact me as soon as possible regarding treatment options.

Signature*

Date*

Phone Number*