Include name, strength, dose and frequency of medication, please be prepared to share the date and time the last dose of each medication was given when your pet is admitted.
Please understand that certain additional procedures will have to be approved by the attending veterinarian.
By typing my name below, I hereby state that I am the owner or authorized agent for the owner of the animal identified above and authorize the veterinarians at Belmont Animal Hospital to perform such diagnostics, treatments, and/or surgical procedures as deemed necessary for my pet. The nature and risk of the procedure(s) have been explained to me and no guarantee has been made as to the results or cure. I fully understand that there may be risk and the potential for complications including death. I agree to pay, in full, for services rendered including those deemed necessary for medical or surgical complications or otherwise unforeseen circumstances and understand that an itemized estimate for the cost of the procedure(s) is available upon request. I have read the above conditions for treatment and acknowledge that I may have a copy of this form, if requested.*