Vaccination Consent Form

VACCINATION CONSENT FORM
With my signature hereunder, I hereby consent and authorize the doctors of Hopi Animal Hospital to vaccinate my pet. I understand that possible reactions to vaccinations may include the following:
- Itching and scratching around the injection site
- Vomiting and/or diarrhea
- Lethargy
- Lack of appetite
- Facial swelling
- Allergic reactions such as hives and/or red skin
- Anaphylactic shock and/or death
I further understand and agree that the reactions are idiosyncratic and the staff and doctors at Hopi Animal Hospital will not be held responsible for any of the occurrences above. I agree to pay any and all costs in the treatment of the above or similar vaccine reactions.
Pet Name *
Owner Name *

First Name Last Name
Owner Signature *

Clear
Date *

Month Day Year
Date
What vaccines does your pet need?
Dog Vaccinations:

DAPPV $29-$58 (requires exam) Rabies $29 (requires exam) Bordetella $35 (must be current on annual exam) K9 Influenza $35 (must be current on annual exam) Lepto $35 (must be current on annual exam) Exam $63
Feline Vaccinations:

FVRCP $29-$58 (requires exam) Rabies $29-$58 (requires exam) Felv $29 (requires exam) Exam $63
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VACCINATION CONSENT FORM