Please complete the attached questionnaire for each pet, this questionnaire is intended so that we can get to know your pet better to create a stress-free as possible experience for them and to ensure their needs are met.
____ (initial) Photos and Publicity Your pet may on occasion be videotaped, photographed, and recorded during their visit for promotional and educational purposes and to document treament progression. Should this occur Animal Care Services shall be the sole owner of all copyrights and all proceeds of taping, photography, and recordings with the rights, throughout the world, and we reserve the rights to produce, display, distribute and use an unlimited number of times and in perpetuity and license to others in any manner. Your pet may be used in any and all media and in the promotion, advertising, sale and publicizing, and exploitation of Animal Care Services at no cost to us.
We will provide you with an estimate of fees for your pet’s medical care. You will have the opportunity to approve or decline all recommended procedures or medications. Your estimate will be adjusted to reflect only the services that you wish to pursue. Upon approval of the estimate, you will be invoiced for the items approved. THE BALANCE IS DUE AT DISCHARGE. HOSPITALIZATION/ANESTHESIA PROCEDURES If your pet is admitted to hospital due to an illness or if scheduled for a sedation or an anesthesia procedure, you will be required to pay a deposit which will be the total amount of the low-end of the estimate provided for the procedure. If you cannot meet this requirement, our front desk team can assist you in applying for Care Credit.
I verify that I am the owner (or authorized agent) of the above named pet(s) and hereby authorize any treatment and/or services deemed necessary by the veterinarian for my pet(s) health and wellbeing to be performed by the veterinarian and staff of Animal Care Services while at of the hospital. Should I be absent from the premises, I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me or my designated representative before, if time permits, proceeding with a service or treatment. I agree to indemnify, defend, and hold Animal Care Services harmless from and against any and all claims, actions, causes of action, losses, damages, liabilities, costs, judgments and attorney’s fees to which Animal Care Services may become subject to, relating to or arising out of your pet’s presence at our facility or caused by your pet. I hereby waive all claims and release Animal Care Services from all liability to your person, your pet(s), your employees, agents, representative, successors and assigns for liability, claims, damage or demands for personal injury, death or property damage known or unknown, past and future, arising from or related to Animal Care Services pet care services provided whether the illness, injury, death or property damage occurs on Animal Care Services premises. This release includes, without limitation, any personal injury, death, or property damage caused by the active or passive negligence of any person associated with Animal Care Services. You shall bear sole responsibility for any and all loss. I understand that I will be financially responsible for all services, including emergency procedures as discussed and agreed upon in the Estimate of Charges provided to me in person or over the telephone. I understand that professional fees are to be paid at the time services are rendered and a deposit is required on all pets admitted to the hospital. Additional Services We also provide non-medical Boarding services, ask a team member for additional information. AUTHORIZATION TO RELEASE PETS’ MEDICAL RECORDS. In the event that a third party (ie. Alternative veterinary hospital, specialist, consultant, new owner) requires a copy of my pets records, I hereby authorize the release of my pets’ medical records. I also release Animal Care Services, its staff and contracted agents from all responsibility and liability for that choice.