I, the undersigned owner, an agent of the owner, or Good Samaritan am responsible for seeking veterinary care for the pet identified above, certify that I am eighteen years of age or over and consent to the examination of this pet by staff veterinarians at CNYVMS/Dr. Heather’s House Calls. I also agree that after consultation with me, the hospital’s doctors may medicate, treat, hospitalize, sedate, anesthetized, and/or perform surgery on my pet.

If an anesthetic procedure is required, I understand and accept that some risks always exist with anesthesia and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. I understand that a doctor or staff member has provided an estimate for recommended services (either verbal or written). Veterinary examinations often require in-depth tests to determine a diagnosis and estimates cannot always predict actual fees.

I agree that either I or an authorized agent of mine, will pick up this pet and that payment for all services is due at the time of discharge unless prior arrangements have been made with the Veterinarian. If no contact is made within 3 days regarding your pet, the staff at this veterinary practice may handle this abandonment in a manner that is in the best interests of the pet, the hospital, and in accordance with New York State law. My financial responsibility shall not in any way be altered by such action. Should it become necessary for the practice to collect the unpaid amount through an attorney or collection agency, I agree to pay all costs of collection, including reasonable collection agency or attorney’s fees.

I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I realize that results cannot be guaranteed and my financial obligations remain, regardless of the outcome. I have read and understood this authorization and hereby consent to the recommended care. I have also been advised that CNY Veterinary is not a 24 hour staffed facility and that there is not a staff member in the clinic at all times.