DROP-OFF RELEASE FORM

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Thank you for bringing your pet to Northeast Animal Hospital or Downtown St. Pete Vet Clinic. Please take a moment to review our policy for visits to our practices. Your authorization is also needed for the care of your pet in the event unforseen circumstances arise.

ACKNOWLEDGMENTS

All pets entering the Hospital or Clinic (Northeast Animal Hospital or Downtown St. Pete Vet Clinic) must be current on all required vaccinations, including heartworm test and fecal; and be free of fleas and ticks, or they will be treated on admission at the owner's expense. If any vaccines are due, you will be notified at the time of drop off. Bordetella and fecal must be current within the last six months.

If medications are necessary for treatment or handling, I give my permission to the Hospital or Clinic to administer such medications.
The staff of the Hospital or Clinic are to use reasonable precautions against injury, or escape, of the animal(s), but the staff will not be held liable or responsible in any manner whatever, or any circumstances, on account of the care, treatment, or safe keeping of the animal(s) above described, or otherwise in connection therewith, as it is thoroughly understood that I assume all risks.
Pets are released only during regular business hours. I realize that it is my responsibility to notify the Hospital or Clinic if I am delayed or otherwise unable to pick up my pet on the designated pick up date. Written notice will be mailed to the above address if the animal is here longer than the designated time. Five days after such written notice, the animal(s) will be considered abandoned and discharged to Animal Services, and it is understood that the Hospital or Clinic's doing so does not relieve me from paying all costs of your service and the use of your Hospital or Clinic.

If you are dropping off your pet for treatment…

I prefer to be called at my most accessible phone number (provided below) about questions regarding my pet or to let me know that my pet is ready for discharge.

If an illness or an emergency situation arises…

I authorize the Hospital or Clinic to do whatever the Doctor deems necessary to care for my pet.

If your pet's visit includes an extended stay, including for boarding…
*

In the event a medical issue arises, I prefer the following treatment option:

I do not require the Hospital or Clinic to obtain my permission for treatment of my pet during his/her stay.

I do not require the Hospital or Clinic to obtain my permission for treatment of my pet during his/her stay as long as the treatment total is less than $100.

I REQUIRE the Hospital or Clinic to obtain my permission for ANY treatments that my pet may need during his/her stay unless they are deemed emergent by a Doctor and I am unable to be contacted.

First Name *

Last Name *

Best Phone Number *

Email Address *

Pet Name *

Signer Name *

Please type your full name. By providing your name, you agree to and acknowledge the statements above.

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