I, the undersigned owner or Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am over eighteen years of age, and hereby consent to the examination of this pet by staff veterinarians at Manlius Veterinary Hospital. I also agree that after consultation with me, the hospital's doctors may prescribe medication for, treat, hospitalize, sedate, anesthetize and/or perform Surgery on this animal I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. Should some unexpected life-saving emergency care be required and the attending veterinarian is unable to reach me, the .hospital ' s staff has my permission to provide such treatment and I agree to pay for such care.
I understand that an estimate of the costs for veterinary services will be provided to me at my request and that I am encouraged to discuss all fees attendant to such care before services are rendered and during this pet's ongoing medical treatment. If this animal is hospitalized, I agree to pay a deposit of 50% of the higher estimated fees and assume financial responsibility for the balance of all services rendered on a cash, credit card or check basis at the time the pet is discharged from the hospital. In the event the pet is hospitalized for more than 48 hours and the attending doctor is unable to reach me, I understand it is my responsibility to call the hospital at least every 48 hours to inquire as to the medical status of this animal and the fees incurred for medical services up to that day. In the event of an unpaid balance, I agree to pay financing fees and any attorney or bank fees related to the collection of this debt.
I agree that either I, or an authorized agent of mine, will pick up this pet within 5 days after receiving written or oral notification that this animal is ready to be released from the hospital and pay for all accrued charges at the time of discharge. Such notice will be given at the address and phone numbers maintained on the hospital's patient/client record. I agree that if I fail to comply with this policy, the Manlius Veterinary Hospital may handle this abandonment in the best interests of the animal and the hospital.
Names of pets*
Species of pets*
Owner name/names*
Owner Signature*
* = required
