I, the owner or authorized agent of animal(s) named: hereby
authorize the veterinarians and staff of Silver Bluff Animal
Hospital to examine, prescribe treatment for and perform
procedures that are deemed medically necessary for the health
of my animal(s). I authorize the veterinarians and staff
of Silver Bluff Animal Hospital to perform any emergency
treatments on my animal(s) in the event that I, the owner
or authorized agent cannot be reached. I assume all financial
responsibility for all charges incurred during the care of
my animal(s). I understand that all charges will be paid
in full at the time of treatment or release of the animal(s)
from the hospital. In the event that a non-elective surgery
or other invasive procedure should be performed, I understand
that a deposit will be made prior to said procedure of ½ the
estimated total cost. I have read and fully understand this
authorization for medical treatment and financial responsibility.
Signed: Date:
I give Silver Bluff Animal Hospital permission to fax, mail, or e-mail my pet's records to other veterinary offices, boarding facilities, and/or grooming facilities as needed.
DOB