DOWNLOAD FORM FacebookThis field is for validation purposes and should be left unchanged.HIALEAH ANIMAL CLINICGENERAL CONSENTOwner's Name First Middle Last PhoneEmergency PhoneName of PetDog? Dog Cat BreedColorAccAgeSex Male Female Spay/Neutered Yes No I AUTHORIZE HIALEAH ANIMAL CLINIC,TO PERFORM THE TREATMENT PROCEDURE OR OPERATION DESCRIBED BELOW. I HAVE BEEN INFORMED OF THE REASONS FOR THE TREATMENT PROCEDURE(S), ALONG WITH THE EXPECTED BENEFITS AND RISKS INVOLVED.PLEASE SELECT SERVICE YOUR PET NEED Yes Regular Bath SMALL (<15lbs) MEDIUM(<16-30lbs) LARGE(<35-50lbs) X-LARGE(<51lbs) DIP (Fleas and Thicks treatment)Medicated BathVaccinesFecal TestSedation/AnesthesiaX-RayCBCCHEMEKGVomitingOtherDiarreahCoughingSneezingEating DisorderI UNDERSTAND THAT UNFORESEEN CONDITIONS MAY REQUIRE AN EXTENSION OF A PLANNED PROCEDUREOR OPERATION. I HEREBY AUTHORIZE THE PERFORMANCE OF SUCH PROCEDURES OR OPERATIONS AS ARE NECESSARY AND ADVISABLE IN THE PROFESSIONAL JUDGEMENT OF THE VETERINARIAN. THERE IS NO MEDICAL STAF AFTER OFFICE HOURS.I UNDERTAND THAT I ASSUME ALL RISKS, I ASSUME RESPONSIBILITY FOR ALL CHARGES INCURRED IN THE CARE OF THIS ANIMAL AND ALSO THAT THESE CHARGES WILL BE PAID AT THE TIME OF RELEASE.Owner's SignatureDate MM slash DD slash YYYY
