Treatment Authorization and information/Photo Release
I, the undersigned owner or agent of the pet identified above, certify that I am eighteen years of age or older and I am the owner, or agent of the owner, of the above described pet and have the authority to execute the consent. I authorize Veterinary Emergency & Specialty Center of Northern Arizona to examine and perform any medical and initial diagnostic/surgical treatments necessary for my pet.I understand that I may cancel treatment at any time before being performed by contacting the doctors and/or assistants.
We are leaders and teachers in the veterinary medical field and often share your pet’s information. The information shared may be in form of photos, forms, lab results, etc. These items are used for continuing education, web sites, veterinary literature, and all things alike. Patient confidentiality will be maintained (names withheld). I hereby release this information for these purposes.
All payments are due at the time of service. If your pet requires hospitalization, an estimate will be presented and a deposit required. Upon discharge of your pet the remaining balance will need to be paid in full. We accept credit cards, Care Credit, cash, and check (with Driver’s License).