Authorization for Medical Treatment

hereby authorize the veterinarian (and associates or assistants) to treat the above-named animal.

I have received a treatment plan with anticipated costs for the procedure(s). I also assume financial responsibility for all charges incurred to the patient and understand payment is due in full at the time of discharge.

*A deposit of 50% will be paid at admission, and the remaining balance will be paid in full at the time the patient is discharged from the hospital.

I understand that for health and safety reasons all pets must have current vaccinations (given within the previous 12 months for most vaccines) for boarding grooming and hospitalization. Dogs must be vaccinated for Canine Distemper Combo and Rabies. Cats must be vaccinated for Feline Distemper Combo and Rabies.

The Pet Doctors Animal Clinic is authorized to assume ownership of said animal and determine care as they see fit if the owner, or authorized agent of owner, does not call for and pay all accrued charges on the animal within 72 hours after notification that the animal is ready to be discharged from the hospital. I understand this action will not, however, relieve me from paying all charges rendered, and all legal and /or court costs incurred in connection with collection for services.

I further understand that no guarantee of successful treatment is made and will not hold Pet Doctors Animal Clinic responsible for my animal's recovery. In the unlikely event of an emergency, 

have authorization to perform CPR and other lifesaving measures. I understand that there is a cost for emergency services and, if elected, I agree to pay all charges in full at the time of discharge.

25 E Franklin Ave Minneapolis, MN 55404 612-607-0044