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 Mobile Phone Number*Animal's Name* Animal's Age* Sex* Male Male Neutered Female Female Spayed Breed* Color* HiddenWeight Recommended test, treatment and or procedure recommended by staff or veterinarian. Please write in. Laboratory Testing* Accept Decline Not Applicable Additional lab testing may be recommended, depending on the procedure. Examples include blood chemistry, CBC, etc. Comments or requests? Please note here if you have any comments or special requests.Estimate to be provided before procedure?* An estimate is requested An estimate is NOT requested An estimate will be provided, before commencing procedure, if this choice is selected. A signed/accepted return copy is required.Agreement/Consent* I AGREE AND CONSENTI 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. CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
