Vaccinations
Problem/Sickness
Labwork
Other
Agree
I understand that to effectively diagnose and treat many problems, x-rays, blood test and other procedures may need to be performed. Further, I also understand that in the event of a life-threatening condition, Midlothian Veterinary Clinic staff will make every attempt to stabilize my pet and then attempt to notify me as soon as possible
I hereby also authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you deem to be indicated.
I agree to indemnify and hold Midlothian Veterinary Clinic harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.
I hereby certify that I am the owner of the above named animal or responsible for it and have the authority to execute this consent. I further certify that I will take full financial responsibility for the treatment of this pet. I understand that payment is due in full on the day of treatment unless other arrangements have been made with Midlothian Veterinary Clinic in advance.
Coughing
Sneezing
Vomiting
Diarrhea
Blood in stool
Straining to defecate
Eating normal
Drinking normal
Yes
No
Midlothian Veterinary Clinic
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