Fayettville Animal Clinic Treatment Consent Form

Fayettville Animal Clinic Treatment Concent Form
Pet(s) must be current on vaccinations. If pet is healthy enough, they will be updated at the owner’s expense. If pet is overly anxious, we will administer safe, antianxiety medicines or supplements to help your pet have the least stressful experience.
Procedure
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I consent for the following vaccinations to be given:
Vaccinations:

RabiesDHLP ParvoBordetellaFVRCPFeline Leukemia
Client Name
Pet(s) Name
Client Daytime Contact Number(s)
Emergency Contact Person
Emergency Phone

Area CodePhone Number
ADDITIONAL OPTIONAL SERVICES (additional charges will be applied)

Canine Heartworm TestNail TrimExpress Anal GlandsFlea and tick bathFeline Leukemia and FIV TestFecal exam for parasitesHome Again Microchip for Identification
AUTHORIZATION FOR TREATMENTI hereby authorize FAC to perform such diagnostic, therapeutic and preventative care procedures as described above. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures. I understand that I assume financial responsibility for all services rendered and agree to pay all charges (including boarding costs) upon release of pet from the clinic.

I have read and fully understand this treatment consent form.
In the event of an emergency situation, I authorize FAC to do whatever you deem necessary to treat my pet.

YesNo
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Fayettville Animal Clinic Treatment Concent Form