Pet Name: [esigtextfield name="esig-sif-1610131516714" class="form-control" verifysigner="undefined" size="undefined" label="Your Pet's Name" displaytype="plaintext" required="0" ]
Owner's Name: [esigtextfield name="esig-sif-1610131519243" verifysigner="undefined" size="undefined" label="Owner's Name" displaytype="plaintext" required="1" ]
Procedure: [esigtextfield name="esig-sif-1610130478176" class="form-control" verifysigner="undefined" size="undefined" label="Procedure" displaytype="plaintext" required="0" ]
I can be reached at: [esigtextfield name="esig-sif-1610130482115" verifysigner="undefined" size="undefined" label="Your Phone Number" displaytype="plaintext" required="1" ]
When did your pet eat last? [esigtextfield name="esig-sif-1610130486128" verifysigner="undefined" size="undefined" label="When did your pet east last?" displaytype="plaintext" required="1" ]
Medications given: [esigtextfield name="esig-sif-1610130490704" verifysigner="undefined" size="undefined" label="Medications" displaytype="plaintext" required="0" ]
Microchip?: [esigtextfield name="esig-sif-1610130677373" verifysigner="undefined" size="undefined" label="Reason for visit" displaytype="plaintext" required="1" ]
Estimate Provided? [esigtextfield name="esig-sif-1610130707910" verifysigner="undefined" size="undefined" label="When did your pet east last?" displaytype="plaintext" required="0" ]
I, being responsible for
[esigtextfield name="esig-sif-1610130392733" verifysigner="undefined" size="undefined" label="Your Pet Name" displaytype="plaintext" required="1" ] , have the authority to grant Lakeside Animal Hospital my consent to receive, prescribe for, treat, and/or operate upon my pet. By signing this form below I understand that if my pet is not free of external parasites such as fleas, and/or ticks, my pet will be treated appropriately at my expense. I understand that my pet must be up to date on needed vaccinations such as rabies, distemper, and Bordetella in order to be hospitalized for any period of time at Lakeside Animal Hospital. Otherwise, my pet will be treated at my expense. I understand that pre-anesthetic blood work will be done, at the owner's expense, prior to the patient being anesthetized for his/her safety. I understand that Lakeside Animal Hospital does NOT provide 24 hour staffing for any animal left overnight at the hospital. Staffing hours are Mon-Fri 7am-7pm; Sat 7am,-1pm.
IF my pet is having a dental procedure performed today, I authorize the veterinarian to perform any extractions deemed necessary at the veterinarian’s discretion. I understand that there is potentially an additional cost for this procedure at the owner's expense.
I understand that in the case of an emergency, Lakeside Animal Hospital will do their best in contacting me appropriately as matters appear. If I am unable to be reached, I give Lakeside Animal Hospital permission to do as they see fit in for treating my pet.
