Does your pet have a history of allergies to any drugs or medications?
Does your pet have a history of any illnesses or injuries we need to be aware of today?
Is your pet currently taking any medications? Including any preventatives or supplements.
I am the owner or authorized agent for the pet described above and have the authority to execute this consent. By signing this document, I certify that I am over eighteen years of age. I agree to make myself available by phone between the hours of 8:30am – 6:00pm.
I hereby agree that I have been informed of and understand there are certain risks and possible complications associated with dental procedures and the anesthesia or sedation associated with those procedures, and after being informed of the nature of the dental procedure and those services elected by me, I understand what will be done for my pet.
I am mindful that while Grand Central Veterinary Hospital provides the highest quality of anesthesia, surgical and dental services, it is possible that during the operation/procedure, unforeseen conditions may arise that may require the performance of additional procedures deemed necessary by the veterinarian. I fully acknowledge and understand these risks, knowing that the hospital and the hospital staff will do all that is necessary to minimize these risks. Additionally, I authorize Grand Central Veterinary Hospital to perform any diagnostic, medical treatment, surgical procedure, or dentistry as deemed necessary for any unforeseen medical or surgical complications if one should arise. I will hold harmless and without blame Grand Central Veterinary Hospital, the veterinarian, or any hospital staff members for any complications that should arise during my pet’s medical treatment and care. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian prior to the procedure taking place.
I authorize the use of appropriate anesthesia and pain relief medications as needed before, during, or after the procedure. I have been informed that there are risks associated with the use of any medications.
I understand the practice of veterinary medicine is not an exact science and thus, there are no warranty or guarantees that can be awarded to me as to the results or cure afforded by the treatments or procedures performed today. I have been awarded the opportunity to discuss any questions I may have regarding the care of my pet to my satisfaction, and it is my responsibility to do so. I accept that my financial obligation remains regardless of any outcome.
I will not hold liable Grand Central Veterinary Hospital, the veterinarian, or any hospital staff members for the loss or damage of any personal items (leashes, collars, blankets, etc.) that is left at the hospital. If I neglect to pick up my pet or any personal items within a 5-days from the date below, Grand Central Veterinary Hospital will assume abandonment of my pet or personal items.
By signing this consent form, I agree to leave a deposit in the amount equal to 50% of the estimate for services and pay the full balance due for services rendered by the end of the business day that I pick up my pet, including those deemed necessary by the veterinarian for any medical complications or unforeseen circumstances. Furthermore, I understand regardless of the outcome of treatment, I am responsible for payment of the procedures performed today. If for any reason there are financial restrictions associated with this visit, it is my responsibility as the owner to notify a staff member immediately of such limitations.
** Dental / surgical pick-up times are between 3:00 PM-6:00 PM **