Treatment Consent

1152 Stonecrest Boulevard

Tega Cay, SC 29708

(803) 547-8387

www.baxtervet.com

Treatment Consent

Reason for Visit:*

Client Name*

Patient Name*

I hereby certify that I am the owner of the above-named animal or am responsible for it and have the authority to execute this consent.

Current Medications:

Refills Needed:

I (Do or Do Not) authorize the use of such sedatives/anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you determine to be indicated.*

I do authorize such use.I do not authorize such use.

I agree to indemnify and hold Baxter Veterinary Clinic harmless from and against any and all liability arising out of the performance of any of the procedures referred to above. In the event of a life-threatening emergency, I do / do not authorize Baxter Vet staff to perform CPR on my pet.*

I agreeI disagree

Electronic Signature*

My signature above verifies that I am at least 18 years of age and am financially responsible for this pet. With this signature, I agree to the terms and services discussed on this consent form.)

Best Contact name and #:*

You will be contacted by text message when your pet's care is complete.