Consent for Treatment and/or AdmissionClient’s Name*Pet’s Name*What phone # is best to contact you today?*Email* I, the undersigned owner, certify that I am eighteen years of age or older, and hereby consent to the examination of this pet by staff veterinarians at Southwest Virginia Veterinary Services. 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 pet as discussed. 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 Dr. Rucker/Dr. Meister Jones before the procedure is initiated. Should some unexpected life-saving emergency care be required and Dr. Rucker/Dr. Meister Jones be unable to reach me, this practice’s staff has my permission to provide such treatment, and I agree to pay for all related fees. In addition, I also understand that many times in the course of care, standard pet care/grooming tasks (such as, but not limited to: nail trims, clipping hair away from eyes, or ears, clipping hair for IV placement, or wound care, expressing anal sacs, or trimming hair in a sanitary cut for pet cleanliness) are performed while a pet is under sedation for other, more serious illnesses, or injuries, and I will not hold Southwest Virginia Veterinary Services liable if they are acting in the best interest of my pet. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made. I understand that an estimate of the costs for veterinary services will be provided to me and that I am encouraged to discuss all fees before services are rendered and during my pet’s ongoing medical treatment. If this animal is hospitalized, I agree to pay a deposit and assume financial responsibility for the balance of all services rendered on a cash, credit card or check basis at the time this pet is discharged from the hospital. In the event the pet is hospitalized for more than twenty-four hours and the attending doctor is unable to reach me, I understand it is my responsibility to call the hospital at least once daily to inquire about my pet’s care and the fees incurred for medical services up to that day. If my pet is hospitalized beyond the first day at this facility, I understand that veterinary care during nighttime hours and/or weekends is provided at the discretion of the attending veterinarian. Continuous presence of personnel may not be provided during these hours. I further agree that either I, or an authorized agent of mine, will pick up my pet and pay for all accrued charges on the date and time agreed upon with the doctors and/or staff of Southwest Virginia Veterinary Services. I agree that if I fail to comply with this policy, this practice will handle this abandonment in the best interests of the pet and the hospital, and I will be responsible for all fees incurred. SignatureCommentsThis field is for validation purposes and should be left unchanged.
