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.
Street Address Line 2
State / Province
Postal / Zip Code
I consent for the following vaccinations to be given:
Client Daytime Contact Number(s)
Emergency Contact Person
ADDITIONAL OPTIONAL SERVICES (additional charges will be applied)
Canine Heartworm Test
Express Anal Glands
Flea and tick bath
Feline Leukemia and FIV Test
Fecal exam for parasites
Home 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.
Should be Empty: