Consent to Treat:

I, the undersigned owner or agent, hereby consent and authorize the Animal Behavior Wellness Center, Dr. Amy L. Pike, Dr. Amy Learn, Dr. Esther Eng, Dr. Megan Buchanan, Dr. Sameera Nalla, Dr. Kelly B. Engler, and designated associates to evaluate, examine, diagnose, develop a treatment plan, prescribe for, and such additional procedures as are considered therapeutically and/or diagnostically necessary on the basis of findings during the course of said evaluation. I also consent to the administration of anesthetics, psychotropic medication, or sedatives, as needed. 

I acknowledge that examination and/or treatment is to take place in my home or the referral facility as agreed upon, and assume all risks arising in connection therewith, including damage or injury resulting from any actions of my animal.

I further understand that reactions of my animal to certain drugs or treatment may be unknown in advance and assume all risks in connection with the use of the same. The doctor(s) are to use all reasonable care and precautions, but it is understood that I assume all risks except negligence on their part.

I further assume financial responsibility incurred to the patient(s) at the time of services rendered. 

I further understand that no treatment will proceed without prior verbal or written consent obtained from me after discussion with Drs. Pike, Learn, Eng, Buchanan, Nalla, or their associates regarding the planned treatment or prescription, and at any time I may refuse either all or part of the recommended treatment, training, or products.

I acknowledge that the Animal Behavior Wellness Center employs a medical transcription service to transcribe appointment notes and plans, and that conversations during the appointment will be recorded for the sole purpose of ensuring my animal’s medical record is accurately maintained.

Media Release:

I hereby grant permission to the Animal Behavior Wellness Center, hereinafter known as “Media,” to use my pet’s image (photographs and/or video) for use in Media publications to include, but are not limited to, educational material, client resources, general publications, social media, etc.

I understand that my name (first and last) will never be used in association with these images or videos, but that my pet's name may be used as an identifier. 

I hereby waive any right to inspect or approve the finished photographs or finished matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

Research Release:

I hereby grant Animal Behavior Wellness Center, and it's designated researchers, permission to analyze and publish my pet’s medical and behavioral history, diagnoses, treatment plans, and treatment outcomes, in order to further research in the veterinary behavior field. I understand that my name, my pet’s name, and any otherwise identifying information will remain private and protected under the legal and ethical umbrella of patient-doctor privilege and confidentiality.