Belmont Animal Hospital - DROP OFF CONSENT FORM

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Pet Name
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Owner
First Name
Last Name
3
Contact Details
Contact Number
Secondary Contact Number
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4
Reason for Drop Off
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Additional Requests or Procedures
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Pet’s Previous Health Concerns
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Current Medications
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Date
Date
Year
Month
Day
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I understand that every effort will be made to contact me by the staff at BAH prior to additional diagnostics and therapies following initial examination. I understand that if I am unavailable, the doctors may elect to proceed with diagnostics and therapeutics for my pet based on their judgment. I understand the necessity of this and agree to pay for all services at the time of discharge.
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