I also authorize up to the amount listed below for diagnostics or treatments deemed necessary by the doctor.
I the undersigned owner or agent of the owner of my pet, certify that I am eighteen years of age or over and authorize the veterinarian(s) at FloridaWild Veterinary Hospital to perform procedures medically necessary. I understand that some risks always exist with drug therapy and medical treatments and I have been encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. By submitting this form, it indicates that any questions I have regarding the following issues have been answered to my satisfaction:
While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, the staff does have my permission to provide such treatment. I agree to pay for such services and understand that those fees are not included in my estimate.
I would like to transport my pet to an overnight facility for after-hours care if deemed necessary.
I would NOT like to transport my pet to an overnight facility for after-hours care if deemed necessary.
I understand that if my pet is to be hospitalized, a deposit of 50% of the estimated cost will be required at the time of hospitalization. The remaining balance will be due at the time of release from our facility unless other arrangements are made in advance.
I have read and fully understand the terms and conditions set forth above.
I understand that checking this box and submitting this form is the equivalent of signing this document in person.
FloridaWild Veterinary Hospital
115 East Euclid Avenue
DeLand, FL 32724
Phone: (386) 734-9899
Fax: (386) 734-1960
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Monday & Friday 8am - 5:30pm
Tuesday 7am - 5:30pm
Wednesday 7am - 7pm
Thursday 8am - 5:30pm
Saturday 9:00am - 1:00pm