Treatment Release Form

I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described below, and that I do hereby grant the doctor, his/her agents, employees, and representatives, full and complete authority to perform diagnostic testing and to perform any other procedure(s) that, at the doctors discretion, may be useful to promote the health of the below described pet. I accept full responsibility for the fees generated by such services, and realize that they are due and payable at the time the animal is released from the hospital (a deposit may be required prior to services).
Do you ever give your pet aspirin?:(Required)
Water Intake(Required)


All fees must be paid in full at the time services are performed or upon discharge from the hospital. Any exception to this policy must be authorized PRIOR to the performance of any service. We accept cash, checks (with ID), MasterCard, Visa, American Express and Discover for your convenience.
Client's Name
Pet's Name
MM slash DD slash YYYY