This is only an estimate of charges, not a quote. This is not a receipt or bill. It is an initial statement prepared to estimate expenses during your animal’s period of hospitalization. We will make every effort to keep you informed of changes to the treatment plan. I authorize the attending veterinarian to use their professional judgment if I cannot be reached when a time sensitive decision is needed and understand I will be financially responsible for any additional services deemed necessary.

I understand that during the performance of procedure(s), unforeseen conditions may arise that necessitate an extension of the above-named procedure(s), or different procedure(s) other than those set forth above, which may include resuscitation. Therefore, I consent to and authorize the performance of such procedure(s) necessary and desirable in the exercise of the veterinarian’s professional judgment.

I agree that the nature and purpose of the procedures, possible alternative methods of treatment, the risks involved, and possibility of complications have been explained to me. I acknowledge that no guarantee or assurance has been made as to the results that may be obtained.

I am the owner or agent for the owner of the above described animal. I am over the age of eighteen. I acknowledge that I have read and understand this consent including any risks associated with the treatment and care of my animal. I agree to assume responsibility for all charges incurred for services and supplies in the course of treatment of problem(s) diagnosed on admission and any resulting complications. I fully understand that all charges are payable in full upon discharge of my animal and/or completion of the treatment period.