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*
MM slash DD slash YYYY
Signature*
Sign with finger if mobile phone or tablet, drag mouse if PC or Mac.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later