Declining Medical Treatment/Procedure Form

Declining Medical Treatment/Procedure Form
Owner Name:*

First NameLast Name
Pet Name:*
Treatment/Procedure Recommended:*
I, the owner of the above named pet, having been fully advised of the importance of treatment or testing for certain medical conditions, do hereby decline the recommended treatment/procedure. I realize that by declining this treatment/procedure, I relieve the veterinarian and hospital of any liability.
Owner Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: