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Surgery Release Form

Surgery Release Form

  • I certify that I own the above described animal and authorize Animal Health Care to perform the listed surgical services. During the hospitalization they may administer vaccinations, medications, tests, anesthetics, surgical procedures and treatments that are deemed necessary for the health, safety and well-being of this animal while under their care and supervision. If the above animal should injure itself in an escape attempt, refuse food, soil itself, become ill, or die while in the hospital, I will hold Animal Health Care and staff free of all responsibility and/or liability in the absence of gross negligence. I further realize that I am responsible for payment of all the above mentioned procedures and treatments in full at the time the animal is discharged. If I neglect to pick up the animal within ten (10) days of written noticethat it is ready for release and mailed to the above address, you may assume that the animal has been abandoned. You are then authorized to dispose of the animal as seen fit. Abandonment, however, does not release me of my obligation for payment in full of said bill. I further agree that in the case of nonpayment, to pay any and all collection or attorneys' fees incurred by Animal Health Care relating to this matter.