DISCLAIMER AGREEMENT: FoHCAS agrees to pay only for the above treatment(s) performed by the Approved Veterinarian on the designated pet, not to exceed the Estimated Expense. Actual amount paid by FoHCAS will be communicated via Confirmation Email to Owner/Foster and Approved Veterinarian. The veterinary bills for Treatment listed above will be paid directly by FoHCAS to the Approved Veterinarian. Owner/Foster will promptly remit copies of all invoices to FoHCAS for payment and/or make advance arrangements for FoHCAS to be invoiced directly. (Note: Owner/Foster does not need to submit invoices for treatment provided by the Humane Society of Tampa Bay.)
Any treatments or medications not listed above will not be covered by FoHCAS and will be the sole responsibility of the Foster/Owner.
Owner/Foster understands that FoHCAS is not a medical provider and makes no representations or warranties, express or implied, regarding any medical care or treatment provided by the Approved Veterinarian. By his/her signature below, Owner/Foster authorizes the Approved Veterinarian to disclose any medical records or health care information related to diagnosis listed above to FoHCAS upon request.
ELECTRONIC SIGNATURE: By providing your electronic signature below, you acknowledge that:
You have provided accurate information to the best of your ability
You have read and understood the disclaimer agreement above