As owner or authorized agent of the animal identified above, I authorize Equerry to perform medical and diagnostic procedures on said animal as required for diagnosis and treatment.I understand that I can refuse or terminate procedures at any time by contacting the attending veterinarian.Emergency procedures may be needed in life saving situations and may be carried out before I am contacted.I also understand I must instruct the veterinarian if there are financial or medical limitations to emergency care.
Hospitalized animals have an increased risk of infection and injury which may occur in association with hospitalization, diagnosis, and treatment.Precautions are taken to prevent injuries and acquired sickness and Equerry does not assume costs for treatment.Patients are closely monitored for signs of infection.Reasonable diagnostic testing of clinically affected or suspect animals to detect contagious microorganisms will be performed at the owner’s expense. Owners are responsible for costs of special procedures required to manage patients suspected of being infected with contagious microorganisms. Owners will receive updated cost estimates whenever additional testing or precautions are necessary.
As owner or authorized agent of the admitted patient, I authorize Equerry to administer agreed on diagnostic and treatment procedures and emergency treatment as considered necessary.I understand that it is my responsibility to inform the attending veterinarian about any treatment or diagnostic test that I do not want my animal to receive.In the event that I sell this animal to another owner, I authorize the release of medical information to the new owner.Equerry considers the identification of a referring veterinarian to imply that I authorize a release of medical record information to that veterinarian.
Equerry is continually reviewing medial information to improve patient care. Therefore, Equerry may use the information in this record for medical studies. However, no identification of owner / agent or patient will be made by name.
I give permission for Equerry to use images of my animal for the purposes of medical studies or education.
I hereby acknowledge that I have read the above, and understand the cited risks. Risks of specific treatment and diagnostic procedures will be explained by attending veterinarians and specific consent forms will be needed. I also understand that no guarantee or assurance can be made to be as to the results that may be obtained.
As agent or owner, I understand that the owner is financially responsible to Equerry for all applicable charges relating to this animal. It is the owner’s obligation to inquire about all costs of patient care and to maintain status of the financial obligation to Equerry. 50 % of the estimate is due at the time of hospitalization and prior to commencement of surgery. Payment of services is due in full at dismissal.If payment is not received in full at the time of dismissal a $25.00 service fee will be administered.Late payment charges of 2 % per month and other penalties specified may be assessed.
