I am the owner/agent of the described animal above and have the authority to execute this consent. I hereby authorize the veterinarian and staff of Twin Cities Animal Rehabilitation + Sports Medicine Clinic to examine and render treatment. I authorize the use of appropriate medical procedures, including sedation and other medications. I realize results cannot be guaranteed. I understand if I am more than 10 minutes late for my appointment, I may be required to reschedule. I agree if the staff feels they are unable to safely examine my pet, I will be charged for the exam/doctor’s time and asked to reschedule a follow-up appointment after precautions have been made.
I understand that cash or credit/debit cards are accepted. If authorization is declined for any reason on a credit or debit card, another method of payment is required. Full payment is required at the time services are performed. A verbal or written estimate will be provided. Pets must be collected by the end of their appointment or a late fee of $30 may be assessed.
If I need to cancel my consultation, I understand I am required to give 24 hours cancellation notice to retain my $100 deposit. If I schedule future appointments and/or therapies, I understand I am required to the best of my ability to give 24 hours cancellation notice otherwise I may be charged the full amount of the scheduled appointment.
TC Rehab's appointment software sends automatic appointment reminders to the email address I have provided, however I understand technology is not infallible and I accept the responsibility of knowing and accurately recording when I have scheduled my appointments.
If my pet is prescribed hydrotherapy:
Hydrotherapy takes place in an underwater treadmill which is supplied by a 300-gallon tank of lightly treated, recycled, and filtered water that is changed on a regularly scheduled basis. When accidents occur in the hydrotherapy tank between these scheduled changes, the tank must be immediately dismantled and sanitized and the 300-gallon tank drained and refilled--this process takes over an hour and is very disruptive to our therapy schedule.
Owners bringing their pets in for hydrotherapy are required to do the following:
> Avoid feeding meals within 2 hours of pet's therapy session.
> Alert staff beforehand if your pet is incontinent or experiences accidents at home.
> Make every effort to have your pet fully defecate/urinate before their hydrotherapy session.
> Alert staff if your pet has not evacuated so that they may express/evacuate if necessary.
> Alert staff if your pet is or has been experiencing soft stools in the last 48 hours.
> Alert staff if your pet has any skin lesions or open wounds.
> Failure to make every effort to prevent an accident in the hydrotherapy tank by adhering to the above requirements may be subject to a $40 dumping and cleaning fee.
Thank you for adhering to our efforts to conserve our resources and keep our patients' therapies on time.
I have carefully read the treatment authorization and the payment policy. By signing below, I agree to all conditions.