I hereby authorize South Atlanta Veterinary Emergency & Specialty, its representative, agent, and employees to administer medical treatment, medications, anesthetics, and surgery as is considered therapeutically, diagnostically, or humanely necessary or appropriate on the basis of the findings during the course of evaluation of the above-described animal.
I understand that the doctor's Exam does not include diagnostics or treatments and that an estimate will be presented to me if these are needed. I understand that a SAVES agent will present an estimate for the above-stated services if I am inside or on the SAVES premises.
If my animal has been considered abandoned by SAVES, I relinquish all rights relating to the treatment of the animal above. I consent to the release of medical information pertaining to the above animal from my veterinarian and/or specialist. I understand that after seeking emergency services at SAVES, I am instructed to follow up with my regular veterinarian immediately.
I HEREBY CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE AUTHORIZATION AND THE REASONS FOR SUCH TREATMENT, MEDICATIONS, OR SURGERY, ITS ADVANTAGES, AND POSSIBLE COMPLICATIONS (IF ANY), AS WELL AS POSSIBLE ALTERNATIVE MEANS OF TREATMENT. I ASSUME ALL FINANCIAL RESPONSIBILITY FOR ALL CHARGES INCURRED TO THE PATIENT AND AUTHORIZE DIRECT PAYMENT TO SOUTH ATLANTA VETERINARY EMERGENCY & SPECIALTY. IN THE EVENT ANY BALANCE DUE HEREUNDER IS NOT PAID AS AGREED, THE UNDERSIGNED JOINTLY & SEVERALLY AGREE TO PAY ALL COSTS INCLUDED IN SAID UNPAID BALANCE, INCLUDING A REASONABLE COLLECTION AND/OR ATTORNEY'S FEES.
PAYMENT REQUIRED WHEN SERVICES ARE RENDERED.
A DEPOSIT IS REQUIRED ON ALL HOSPITALIZED PATIENTS
EMERGENCY DEPARTMENT EXAM FEE IS $135.00