By signing below, I certify that I am the legal owner 18+ years or older, or duly authorized agent for the owner of the animal described above, and do hereby give Tamera Chan, DVM, authorized agents, staff or representatives full and complete authority to euthanize and dispose or arrange for cremation of said animal in whatever humane manner they deem fit. I hereby forever release the said Doctor Tamera Chan, DVM and any authorized agents, staff or representatives from any and all liability for euthanasia and disposing of the said animal. State law requires if this animal has bitten any person or animals or has been exposed to rabies in the last 15 days that animal is to be submitted for post euthanasia rabies testing. In signing this document you are certifying to the best of your knowledge the said animal has not had any such incident. I have read and understand this authorization. To the best of my knowledge, the information I have provided is true. I understand that my wishes may be carried out immediately upon my signing this agreement.
I have read and understand this authorization. To the best of my knowledge, the information I have provided is true. I understand that my wishes may be carried out immediately upon my signing this agreement.
Fees for these services have been explained to me, and I recognize they are my responsibility. I agree to provide a credit card number that will only be charged after I have approved an estimate (verbally, via text, e-mail, or signed estimate). I understand that this card will be used for payment and that once I have confirmed my appointment with a team member that there is a $100 fee for any cancellations or changes made the day of the appointment.
I understand that a cancellation fee of to 50% of the total fees may be applied if Dr. Chan is already en route by the time I have cancelled. I understand that if cancellation occurs once Dr. Chan is in my home, the in-home Quality of Life consult fee of $350 will be charged in lieu of the euthanasia service, plus additional travel/aftercare/after hours fees.
Furthermore, I understand that a non-refundable deposit of $100 may be charged upon completion of my booking for a same day appointment, which will be applied to my remaining balance.