As the owner (or authorized agent for the owner), I do hereby consent and grant the veterinarian(s) of Trident Veterinary Hospital and all of their employees, agents, servants, and/or representatives (collectively, the “Hospital”) full and complete authority to perform the procedures and treatments described above and to perform any other procedure or treatment that, at the attending veterinarian’s discretion, may be deemed medically necessary and I do hereby forever release and discharge the Hospital from any and all liability arising from such procedures and treatments.
I understand that all fees associated with the above-authorized care are expected to be paid in full at the time of pick-up.
I do hereby consent and agree that photographs and digital recordings of my pet obtained during hospitalization may be used for the purpose of medical case reports, education presentations and advertising purposes. Client confidentiality will be maintained
Financial responsibility
I understand that an estimate of the costs for veterinary services will be provided to me and that I am encouraged to discuss all fees related to such care before services are rendered and during this pet’s ongoing medical treatment.
I understand that I am responsible for all costs associated with the above approved procedure. I understand that payments are due at the time of service.
Procedure authorization
My veterinarian has explained to me that while a satisfactory result is expected, all operations and procedures carry a risk of unsuccessful results, complications, injury or even death, from both known and unforeseen causes.
I understand that there is no certainty that my pet will achieve all of the expected operation or procedure benefits and no guarantee has been made regarding outcome. I have been informed of the following: • The nature and purpose of the operation or procedure, including related care, treatment and medications. • The potential benefits, risks or side effects of the operation or procedure and its recovery period • The likelihood of achieving the treatment goals • Reasonable alternatives and their relevant risks, benefits and side effects • The possible outcomes related to not receiving care or treatment. • The possibility of incurring additional costs as a result of any complications
Check off each line, please.
