PHONE: 678-985-5530
FAX: 678-985-2730

1835 Grayson Hwy (GA Hwy 20)
Grayson, GA 30017

*** ALL PAYMENT IS DUE AT THE TIME OF SERVICE ***

I authorize the Doctor and or staff at EASTSIDE ANIMAL MEDICAL CENTER to administer treatment and medication as is considered necessary. I will honor all financial commitments incurred in the diagnosis and treatment of the patient above and understand that all financial obligations will be satisfied prior to the dismissal of the patient I understand that EASTSIDE ANIMAL MEDICAL CENTER will contact my primary veterinarian and will release the patient's medical record for emergency services to my primary veterinarian. I understand that all problems may not be resolved and will arrange for follow-up care with my primary veterinarian as instructed.

If my pet experiences cardiac and/or respiratory arrest (lack of heartbeat and/or breathing), I request the veterinarians and staff of EASTSIDE ANIMAL MEDICAL CENTER to perform CPR to restore heart and/or respiratory function. I understand that medications, equipment, and procedures utilized during CPR attempt will be billed in addition to the estimate given for examination, medications, and treatments - and will generally result in an additional expense of $750.00 or greater. I have read the above authorization and fully understand the reason for medication and or treatment. I have been informed of potential complications and the fees that will be incurred in the course of treatment.

I understand that a late pickup fee of $41.00 will be applied anything after 6pm.