AUTHORIZATION FOR MEDICAL AND/OR SURGICAL TREATMENT
I hereby authorize the doctor on duty (and assistants the doctor may designate) to administer treatment and medication as is considered therapeutically or diagnostically necessary or appropriate on the basis of findings during the course of evaluation of the above described animal. I also consent to the administration of such anesthetics and surgery as they are necessary or appropriate under the circumstances. I also consent to the release of medical information. I will arrange for follow-up care as instructed.
I HEREBY CERTIFY THAT I HAVE READ AND FULLY UNDERSTANT THE ABOVE AITHORIZATION AND THAT I FULLY UNDERSTAND AND AGREE WITH THE REASONS FOR SUCH TREATMENT, MEDICATIONS OR SURGERY, ITS ADVANTAGES AND POSSIBLE COMPLICATION 9IF ANY0, AS WELL AS POSSIBLE ALTERNATIVE MODES OF TREATMENT, ALL OF WHICH HAVE BEEN EXPLAINED TO ME BY THE DOCOTOR OR DESIGNATED ASSISTANT.
I ASSUME FINANCIAL RESPONSIBILITY FOR ALL CHARGES INCURED TO THE PATIENT and authorize direct payment to South Atlanta Veterinary Emergency & Specialty Center.
South Atlanta Veterinary Emergency & Specialty Center will occasionally record photos, video, and /or audio to publish on various medical sites (Facebook, SAVES Center website or printed materials) for the purpose of education, or marketing. Please accept or decline the release below: