Authorization for Non-Surgical Procedure Form

Authorization for Non-Surgical Procedure
Owner's Name
Owner's Name
First
Last
Preferred method of contact for updates

Medical History

Is your pet eating/drinking normally?
Did your pet eat this morning?
Is there any changes in urination/defecation?
Any vomiting/regurgitation?
Respiratory concerns (coughing, sneezing, trouble breathing)?
Changes is attitude/energy level/behavior?
In the event of spontaneous arrest (heart rate, breathing, etc.), I elect the following (please select one)

Please read below and sign

  • I hereby authorize American Animal Hospital to perform such diagnostic, therapeutic and surgical procedures as are, in their opinion, necessary and advisable for treatment and maintenance of my pet’s health and well being. The nature of such services has been described to me to my satisfaction and, while I expect all procedures to be done to the best of the abilities of the professional staff, I realize that no guarantee or warranty can ethically, or professionally, be made regarding the results or cure.
  • I understand that I assume full financial responsibility for all services rendered, regardless of outcome.