I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute
this consent. My signature below certifies that I am over eighteen years of age.
Pondview reserves the right to treat my pet for fleas, ticks, lice, earmites, or worms if found during routine examination or
during the procedures listed above.
If overnight supervision is required and I elect to pick up my pet and provide care in my home, I accept all risks of adverse
effects. I am aware that I have the choice to transfer him/her to a local emergency clinic where overnight veterinary
supervision is available at my expense.
I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for
successful treatment. I have been informed that there are certain risks and complications associated with sedation,
anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further
understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate
the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any
concerns I have about these risks with the attending veterinarian. I accept that my financial obligations remain regardless
of the outcome and payment is due at time of patient discharge.
I am aware that payment is required at the time of service and due upon checkout. Treatment of my animal is determined by my decisions, with consideration of my financial resources. If any charges are not paid when due, interest will accrue at 2.0% per month. Any collection expenses, including attorney fees, are my (the owner's) responsibility. Pondview Veterinary Clinic accepts the following types of payment: cash, check, Visa, Mastercard, American Express, Discover, Care Credit and Scratch Pay.
I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.