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 $25-$50 (requires exam) Rabies $25 (requires exam) Bordetella $25 (must be current on annual exam) K9 Influenza $25 (must be current on annual exam) Lepto $25 (must be current on annual exam)
Feline Vaccinations:

FVRCP $28-$56 (requires exam) Rabies $25 (requires exam) Felv $28 (requires exam)
Should be Empty:

VACCINATION CONSENT FORM