 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
Services
Letter to Editor 2
Dangerous Dogs Act
Cat and Kitten Vaccinations
Puppy Milk Replacer
Pet Survey
Interesting Links
Links for Veterinarians
Interesting Pictures
Conscent Form
Boarding Services
Boarding Check List
Article
Software
Vet Care Management ProgramVeterinary Clinic
Home PageAbout usVeterinary, care
SpayPost Surgical Care For a Spayarticles on veterinary medicin
Letter to Editor 1|
|
| Hospital Conscent Form |
| ||||||
| Central Animal Hospital #77 Main Rd. Montrose, Chaguanas. Tel: 868 665 7711; 665 PETS Medical / Surgical Release & Financial Responsibility Form To be completed for every Hospitalized animal. DATE: ______________________________/_______/200__________ NAME OF CLIENT_____________________SIGNATURE: ___________________________ NAME OF ANIMAL________________________DESCRIPTION__________________________________ TODAY’S EMERGENCY PHONE NO._______________________________________________________ MY PET IS ON THE CURRENT MEDICATIONS______________________________________________ HAS YOUR PET BEEN FASTED SINCE MIDNIGHT LAST NIGHT?(CHECK ONE) ð YES ð NO ð N/A HAD NO WATER SINCE MIDNIGHT LAST NIGHT? (CHECK ONE) ðYES ð NO ð N/A I hereby authorize and direct the Veterinarian(s) to administer general anesthetic, parenteral and/or oral medication, and to perform the medical/surgical procedure deemed medically necessary to treat me pet mentioned above. Anesthetics are only administered when circumstances dictate, and then every caution is taken to insure the pet’s well being. The nature of the mentioned procedure(s) has been explained to me and no guarantees have been made as to the result or cure. The Veterinarian(s) agrees to inform the owner of the animals of any expenses other than the fees quoted should circumstances permit; otherwise, emergency procedures or procedures for other unforeseen circumstances will be performed and the owner informed as soon as possible. I release The Veterinarian(s) from any loss or expense these actions might incur on me, provided said actions are necessary to preserve the life of said animal. All charges for services are expected to be paid prior to the animal’s release from the Hospital. If alternate payment arrangements are made in advance, an interest fee of 1.5% per month (18% per annum) will be charged. I also agree that if I do not remove my animal (or fail to make alternative arrangements or have an agent appear) after 3 days from the recommended discharge date, my animal may be withheld/confiscated pending full payments (including all charges {boarding, treatment etc} for the interim period) or sold (or euthanasied after one week of no contact from the owner). Procedure(s) Proposed Fee(s) $ _____________________________________________________________ Sanjay Ramdath DVM |
| Chaguanas. |
|
. |
| Visitors: 00686 |