Drop-Off Consent Form

  • - I, as the owner or authorized agent of owner, grant my consent to the doctors and staff to receive, treat, and/or operate upon the above named pet. I understand that there is risk associated with medical and surgical treatments performed under sedation or general anesthesia. Specific results can never be guaranteed in dealing with the complexities of living animals. I understand that unforeseen complications can result; even though professional, approved, methods will be used by the doctors and staff of Eastern Shore Animal Hospital.
    - I understand that if lives fleas or ticks are found on my pet that flea treatment is required and will be applied at personal cost.
    - I understand that up-to-date vaccinations are required to leave my pet for treatment, all required vaccinations will be updated unless deemed inappropriate by the doctor examining my pet and will be done personal cost.
    - I accept all financial responsibility for my pet and understand that payment for services rendered is due at the time of discharge.
  • I have read and fully understand the terms and conditions set forth above.
  • Electronic Signature
  • MM slash DD slash YYYY