Authorization For Treatment

Owner Name

Pet Name

Date

Phone

Procedure (S):

Hospitalizeation until/for

1. I am the owner/acting agent of the animal named above on account:__________. I am 18 years of age or older and have the authority to give this authorization.
*Account no will be added by hospital team*

2.The doctor or staff member has described the procedure(s) identified above and has explained to my satisfaction the purpose for performing them and risks involving with them. I realize that there can be no guarantee as to the animal's condition, or the outcome of any procedures. I have been advised that in the event that the treatment requires the use of anesthesia/sedation, that there is a risk, even the risk of death.

3. I also understand that unforeseen condition may be revealed during the identified procedure(s), which in the opinion of the veterinarian(s) require more extensive or different procedures and treatments. I understand that reasonable efforts will be made to contact me to explain these procedures and treatments and obtain my consent regarding them. However, if the efforts are unsuccessful, I authorize the performance of any procedure or treatment which is necessary in the professional opinion of the veterinarian(s).

4. I authorize the veterinarian(s) of the Atlas Animal Hospital Vancouver to perform the above identified procedures Except:

I agree to pay, in full, for services rendered including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. I understand that the above given estimate of charges for fee for presently planned procedures is only a best approximation and the final bill may be seen lesser or greater than this amount.

Signature

Authorization for Treatment (Medical/Surgical)

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