Drop Off Form

I am the owner, or agent of the owner, of the above animal and have the authority to execute this consent. I hereby consent and authorize the performance of the above named procedure(s) or treatment(s) and the risks involved. I understand the above anesthetic and surgical, diagnostic or therapeutic procedures may involve risk of complications, injury or even death, from both known and unknown causes and no warranty or guarantee has been either expressed or implied as to result or cure.

I authorize and direct the veterinarians and/or their assistants to provide additional services for the patient as they may deem reasonable and necessary, including but not limited to: the administration of anesthesia; the performance of a treatment, surgery or procedure different from those set forth above; or the performance of services involving pathology, radiology, lab, and/or other diagnostic testing. Furthermore, I authorize the hospital staff in an emergency situation, to follow through with such procedures as are necessary for the wellbeing of my pet on a continuing basis until further communication with me. I agree to assume financial responsibility for all routine and emergency services rendered.

Your signature below constitutes your acknowledgment that (i) you have read and agreed to the above, (ii) the procedure(s) have been explained to your satisfaction and that you have all the information that you desire, (iii) you have the chance to ask questions, and (iv) you authorize and consent to the performance of the procedure(s) and to the administration of anesthesia.