Day stay / Hospitalization Consent Form
Last name: _________________________
First name(s): ______________________________
Pet name: ________________________
Contact Phone number(s): _______________________
Please read and sign below:
- I authorize the admission of my pet to Pismo Beach Veterinary Clinic for diagnostic procedures, medical treatments, and/or hospitalization. The phone number above is my best contact during this time.
- [ ] If checked, your pet is being admitted for a procedure under anesthesia. To increase the patient’s safety as much as possible, we recommend a screening blood panel to make sure the pet is healthy enough to handle the anesthesia. This panel tests for dehydration, anemia, diabetes, liver disease, and kidney disease.
- Circle: I accept / decline the screening blood panel.
- I understand that the doctors and staff will use all reasonable precaution against injury, escape, or death of my pet. I understand that all anesthesia involves some minimal risk to my pet and I will not hold the doctor and staff responsible under any circumstances. I understand that I assume all risks.
- I assume full financial responsibility for this animal and agree to pay all charges upon release or as otherwise arranged in advance.