I, the undersigned, certify that I am the owner, or authorized agent for the owner of the pet(s) named above. I do hereby consent and authorize University Animal Hospital (UAH) and its staff to hospitalize this pet and perform the above described procedure(s), and administer vaccinations, medications, tests, surgical procedures, radiological, anesthetics, treatments and/or emergency care that the doctors deem necessary for the health, safety, and well-being of this pet while it is under the care and supervision of UAH. I have been advised as to the nature of the procedure(s) and the potential risks, and I understand the reason why such medical and/or surgical treatment is considered necessary, as well as its advantages and possible complications, if any. I also understand that no guarantee of successful treatment or outcome can be made.
It is impossible to accurately estimate the total charges involved because the total extent of the injuries or illness may not be immediately apparent. The results of blood tests, urinalysis, radiographs, etc. may be needed before the doctor can approximate a total expense. Additionally, it is impossible to accurately estimate the time and individual animal needs to respond to a treatment plan and this factor might affect the total cost.
If additional treatment is needed that exceeds the estimated range, the hospital will contact me with an updated treatment plan and estimate to obtain my permission to proceed, and I will increase my deposit accordingly. In the event that any urgent care requirements arise and the hospital makes a reasonable attempt but is not able to contact me, I grant permission to render my pet whatever emergency and life-stabilizing treatments are deemed necessary by the UAH doctors and staff. I agree to pay for these emergency and life-stabilizing treatments even if they exceed this estimate.
I assume full financial responsibility for all charges and services incurred to my pet while in the hospital and agree to pay for all such charges at the time of release of my pet.
I hereby certify that I have read and fully understand this authorization for medical and/or surgical treatment.