Drop-off Information Sheet Form

AUTHORIZATION FOR EXAMINATION, TREATMENT, AND ASSUMPTION OF ALL FINANCIAL RESPONSIBILITES:

I, the undersigned, authorized the veterinarian(s) and their staff to examine the patient specifically described and identified above and to administer any medical, surgical treatments and/or test, including sedation or anesthesia which is considered necessary based on findings during the course of examinations. I assume responsibility for all charges incurred for services rendered to the patient upon pick up this pet.