I, Your Name, am the owner or authorized agent of the above described animal and I authorize the performance of diagnostic, therapeutic, anesthetic, surgical and preventative procedures listed above or any emergency procedure that may be deemed necessary by the veterinarian. I have been advised as to the nature of the above procedures or operations and of the risks involved. I realize that results cannot be guaranteed. Your initials are giving consentInitials Here .

I, Your Name, understand the above quoted cost may vary, depending upon the extent of treatment required. A veterinarian or member of the staff will make reasonable efforts to notify me prior to any additional treatment whe the actual cost is expected to exceed this estimate by 30% unless the additional treatment is required as an immediate life saving measure. Your intials indicate understandingYour Initials .

Surgical procedures, if applicable: I have been explained any surgical procedures that are needed. I understand that any anesthetic procedure carries risks. The veterinarian has gone over possible outcomes and I understand the delicate nature of this procedure. I authorize the veterinarian to perform surgery on my pet. Your intials indicate understanding and consentblank .

I, Your Name, do fully understand that by declining this estimate I am electing services for my pet that do not represent the optimal care as advised by Central Carroll Animal Emergency. The ramification of such a decision on my part may include further deterioration of my pet's condition and/or my pet's death. Your initials indicate understanding and consentYour Initials