I certify that I am the owner, responsible agent, or authorized agent of the pet described below. I authorize the
Doctor and staff of Forest Crossing Animal Hospital to perform the procedure and/or services described above,
including the administration of sedative and/or anesthetics, as well as any necessary and appropriate medical,
radiological, surgical, diagnostic, and/or emergency care for this pet. I have been advised as to the nature of the
above described procedure, and fully understand the potential risk(s) associated. I also understand that there is no guarantee of successful treatment.
Furthermore, I understand and agree that if my pet is abandoned at Forest Crossing Animal Hospital without prior
arrangements being made, Forest Crossing Animal Hospital will contact me by certified mail at the address I have
provided. I then have ten (10) days to retrieve my pet. If I have not made contact with Forest Crossing Animal Hospital on or before the tenth (10th) day, Forest Crossing Animal Hospital receives full ownership of my pet.
I agree to pay in full for the services performed, including those deemed necessary for medical or surgical complications, or unforeseen circumstances. The estimate provided is based on the best information currently
available and is not a guarantee of charges.