Pet Care Authorization Form: Nail & Ear Treatment Options
School
Penn Foster College**We aren't endorsed by this school
Course
VET 131
Subject
Industrial Engineering
Date
Dec 10, 2024
Pages
1
Uploaded by DeanSteel15610
¢ veCa . Please Read Carefully Name: 3 Date: Pet's Name: Chart #: Breed: : Sex: Age: Color: ~ Procedures: While your pet is anesthetized, we will have a unique opportunity to optimally trim his/her nails and clean his/her ears. Please check off the appropriate box(es) below if you would like any of these services done. Ear cleaning will be done if a complete exam of the ear canals determines the ear(s) should be cleaned. A microscopic analysis of ear exudate will also be performed if necessary. " Nail Trim$§, O Microchip ~ $. € Meii [ Ear Cleaning $, O Other $ |, the undersigned, certify that | am the owner, or authorized agent for the owner, of the animal described above. | authorize the doctor on duty and assistants to perform the procedures listed above and on the attached estimate, including administration of pain relief medications, sedatives and/or anesthetics, as well as any necessary and appropriate medical, radiological, surgical, nursing, diagnostic, and/or emergency care for the animal. | have been advised as to the nature. of the procedures and the potential risks. | also understand that no guarantee of successful treatment can be made. | have r_eéq and understand the reasons for and the risks of the above and attached authorized procedure(s), and assume full financial responsibility for all charges and services incurred to the | described animal. Signature of Owner/Agent: Date: Print Name: When dld your pet eat last? (time/day) Phone"[‘lur_npers where we can reach you today: (list times available if possible) Work: _ Home: \,‘ 1 - Mobile: Other: STAFF SIGNATURE: For information on how we collect and use information about you and your pet, and how you may opt-out of some uses, please see our Privacy Policy at vcahospitals.com/privacy-policy.
