I, First Name* Last Name* The owner of the appointed caregiver ofpatient name* described above have the authority to execute this consent. I hereby authorize ABC Veterinary Hospital to collect the deposit in the amount of Amount*. I understand that by signing this form, I agree to the following:The deposit collected is to secure and schedule a surgical/ procedure date.The deposit collected will go towards the balance of the procedure. Should I need to cancel or reschedule ABC Veterinary Hospital requires a 3 (three) day notice to be given.The deposit is fully refundable as long as the 3 (three) day notice has been provided. If less than 3 (three) days is provided, the entire deposit will be forfeited and will not be refunded. I understand and agree to pay the balance in full upon check in of my pet. The deposit collection, procedure and relevant cost have been full explained to me, to my satisfaction. I have read, understand and agree to the terms and conditions herein.