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  • Hospitalization and Treatment Consent

  • CLIENT INFORMATION

  • REASON FOR VISIT (choose below)

  • PLEASE READ THIS SECTION CAREFULLY:

    VACCINATION POLICY:  Our hospital recommends that your pet be current on their distemper and rabies vaccinations. We require that in-patients be current on rabies. Proof that a rabies vaccine has been given by a veterinarian is required at admission.  If your pet is overdue for the rabies vaccine, it will be updated pending confirmation of a healthy animal.

    FLEA POLICY: Pets with fleas will be treated in the clinic at additional cost.

  • ADDITIONAL SERVICES OFFERED:

    Please choose, BELOW, ALL procedures you WOULD LIKE PERFORMED today.

  • CONSENT TO TREATMENT:

    I am the owner or agent for the owner of the above-described animal and have the authority to execute this consent. I hereby authorize Heartland Veterinary Clinic to perform the procedure(s) listed above.  I understand that during the performance of the foregoing procedure(s), unseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) that are set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment.  I also understand that I will be responsible for full payment of services at the time my pet is discharged from the hospital.

    I have read and understand this authorization and consent, and being of legal age, I hereby consent and authorize this hospital and its veterinarians and staff to perform the agreed to procedures.

    ESTIMATES AVAILABLE UPON REQUEST

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