Declining Medical Treatment/Procedure Form

Declining Medical Treatment/Procedure Form
Owner Name: *

First Name Last 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 *

Month Day Year
Date
Should be Empty: