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 the above procedure(s). 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 has my permission to provide such treatment. I agree to pay for such services and understand that those fees are not included in my estimate.
the staff does not have my permission to provide such treatment.
I understand that during the performance of medical, surgical, or anesthetic procedures, unforeseen conditions may be revealed that necessitate more extensive, costly, or different procedures that originally planned. If FloridaWild’s staff is unable to reach me, I hereby consent to and authorize the performance of such procedures as are necessary and desirable in the professional judgment of the attending veterinarian, provided that the cost of additional procedures will not increase the total fee by more than 25% of that provided in the estimate. We appreciate your trust and will take excellent care of your pet.
I would like to transport my pet to an overnight facility for after-hours care if overnight hospitalization is required.
I would NOT like to transport my pet to an overnight facility for after-hours care if overnight hospitalization is required.
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