Consent for Treatment

  • Date Format: MM slash DD slash YYYY
  • I, the undersigned owner, authorized agent of the owner or Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am over eighteen years of age, and hereby consent to the examination of this animal by staff veterinarians at this veterinary hospital. I also agree that after consultation with me, the hospital’s doctors may prescribe medication for, treat, hospitalize, sedate, anesthetize and/or perform surgery on this animal. I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian or veterinary technician before the procedure is initiated. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made.

    Should some unexpected life-saving emergency care be required and the attending veterinarian is unable to reach me, this hospital’s staff has my permission to provide such treatment and I agree to pay for all related fees.

    I understand that an estimate of all the costs for veterinary services will be provided to me and that I am encouraged to discuss all fees attendant to such care before services are rendered and during the pet’s ongoing medical treatment.

    If the animal is not claimed by the owner within 10 days of completion of an in-hospital treatment and convalescence, it is deemed to be abandoned and I hereby consent that the veterinarian may dispose of the live animal by transferring the animal to an animal shelter or to a third party owner if:

    1) the client has agreed in writing to the transfer
    2) the veterinarian has attempted to contact the client at least five times by at least two different methods, such as telephone and mail and has documented these attempts
    3) the veterinarian has attempted to contact any emergency person identified by the client


    1. The medical and/or surgical treatment alternatives for your pet.
    2. Sufficient details of the procedures to be performed on your pet.
    3. How your pet might respond to treatment and possible recovery time.
    4. The most common and serious complications.
    5. The length and type of follow-up restraint and care required.
    6. The estimate of the fees for all services.

  • E-Signature