Please fill out the form below


If I have declined the bloodwork prior to anesthesia,
I agree to hold the Animal Care Clinic harmless, in the absence of negligence, in the event of untoward anesthetic complications that might have been detected had these tests been performed.

I hereby authorize the veterinarian of the Animal Care Clinic to examine my pet(s), and prescribe for, hospitalize, anesthetize, or perform surgery on the above-mentioned animal(s). I understand that during the performance of this/these procedures, unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect reasonable care and judgment in performing the procedure(s). The nature of the procedure(s) and risks involved has been explained to me and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding this/these animal(s). I, the undersigned, whether or not the owner, assume financial responsibility for ALL services rendered, including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances.

Please feel free to call or submit questions prior to surgery. Allow 12 hours if submitting a question.