I hereby authorize Buffalo Ridge AH, it’s representative, agent employees, to perform the surgery and/or other services described herein, on the above described animal and do hereby release and forever discharge Buffalo Ridge AH. It’s representative, agent or employees, by reason of said surgery, administration of drugs or performance of other services, and any consequences resulting directly or indirectly therefrom.
I further certify that I have ordered, or have been authorized by the owner to order the services herein for the above described animal. In any event, I accept full financial responsibility for the payment for services ordered and rendered. I understand that any animal not called for within 3 days of the date that the hospital shall designate for its release shall be considered abandoned by me, and shall be disposed of at the discretion of the hospital. Abandoned animals are subject to prosecution under Florida Statutes. My financial responsibility shall not in any way be altered by such disposal and my indebtedness shall include all charges made against such animal up to and including the date of, and charges for disposal of same. Should it become necessary to collect this amount through an attorney, the undersigned agrees to pay all the costs of collection, including a reasonable attorney’s fee. If this account is assigned to a collection agency, an additional fee of 40% of amount owed will be added. Unpaid balances accrue finance charges of 18% annually.