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Please read all the information below BEFORE initialing AND select YES or NO

I realize there are anesthetic risks involved, as well as risks associated with medical and surgical procedures. Such risks include, but are not limited to, a reaction to the anesthetic or administered medications resulting in the death of my animal. I hereby release Pickrell Veterinary Clinic and its owner(s) and employee(s) from all responsibility of such complication(s).

The procedure and my financial obligations have been explained to me to my satisfaction. I realize that no guarantee nor warranty can be ethically or professionally made. I am also aware that the price quoted me is the projected price of the procedure to be done with my pet. I am aware that certain variables (that are not at this time foreseen) could result in a change in price.

Diagnostics

Medicine

Spay

I understand that I assume financial responsibility for all services rendered and that payment is considered due when my animal is discharged from the clinic. Down payment may be required before hospitalization medical or surgical care. Pickrell Veterinary Clinic reserves the right to refuse hospital admittance and treatment. If the pet has already been admitted, Pickrell Veterinary Clinic reserves the right to refuse release of the pet until payment arrangements are made to the satisfaction of the clinic.

By signing below, I agree to all terms and conditions. I acknowledge that I have read, understand and agree to all of the information contained in this contract. I have the right to ask questions before signing.