General Consent Form

Prior to acceptance for a scheduled procedure, answers to the following questions are important to ensure the safety of your animal and appropriate services are rendered.

Owners First and Last Names*
First Last
Animal's Name*
Animal's Age*
Sex*
- Male
- Male Neutered
- Female
- Female Spayed
Weight*
Recommended test, treatment and or procedure recommended by staff or veterinarian. Please list
Comments or special requests?
Please note here if you have any comments or special requests.
Agreement/Consent*
I AGREE AND CONSENT
I consent and agree to the services recommended to and listed by me, above. I understand there are additional charges for services as listed. While a verbal estimate should be requested and typically provided, by ticking this box and signing below I decline a written estimate unless already provided in advance for the above listed recommended tests, procedures or treatments.
Date of agreement and consent*
Date Format: MM slash DD slash YYYY
Signature*
Sign with finger if mobile phone or tablet, drag mouse if PC or Mac.
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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