Consent for Veterinary Services

(If more than one horse, I consent that all of my horses brought to De Cillo Equine Clinic may receive Veterinary Services.)

I, as owner of Horse listed above, understand that now, and from time to time in the future, it may become necessary that Veterinary Examination, Treatment or Consultation be provided. In the absence of specific instruction to the contrary, or in the even that I cannot be reachec, I hereby authorize my agent:

My agent may act on my behalf in the arrangement of such services with a licensed Veterinarian. Further, I agree to be responsible for the payment of all fees incurred. I understand that this payment must be made when services are rendered, or in the case of hospitalization, payment must be made weekly until my horse is discharged. I further understand that my entire billing account must be paid in full for my horse to be released to me.