Wilmot Veterinary Clinic

519-696-3102

1465 Trussler Rd. Kitchener, ON N2R 1S7

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Consent Form For Diagnostics, Treatment or Surgery

Wilmot Veterinary Clinic Prof. Corp. 1465 Trussler Rd, Kitchener, ON,N2R 1S7

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I, the undersigned, an adult major, hereby authorize the veterinarians and staff of this veterinary facility to perform any reasonable treatment/anesthesia & surgery they may deem necessary, including further or alternative measures as may be necessary during the course of the surgery &/or treatment of my animal.
I'm aware that this veterinary facility doesn't provide 24- hour per day monitoring of patients. Should I wish to have my animal monitored 24 hours per day while hospitalized, I will make arrangements with the staff of this facility.
I, undertake to keep in daily contact to enable the staff to inform me of the progress, costs incurred, and additional treatment involved, of my hospitalized animal. I may withdraw my consent at any time for any treatment or procedure.
I recognize that there is some degree of risk attached to any medical or surgical procedure or treatment. I have discussed any concerns I may have with the veterinarian. I hereby absolve the veterinarians, staff and this facility from all actions, arising directly or indirectly from the treatment/anesthetic/surgery.
I herby acknowledge that Dr. Lofsky, or his/her representative, has advised me of and explained the following proceedureor tenative or final diagnosis of my animal listed below, the general nature of the following procedure or tentative or final diagnosis of my animal listed below, the general nature of the following proposed treatment or proceedure with the expected benefits, risks, dangers, side effects and consequences if the treatment/procedure is not performed.
In the event that the animal referred to above is not claimed by the person giving this consent within ten days of completion of the discussed treatment and convalescence or of any ancillary service provided by the Wilmot Veterinary Clinic, the animal shall be deemed to have been abandoned, and Wilmot Veterinary Clinic shall be entitled to transfer the animal to an animal shelter or to a third party owner.
I acknowledge that I have read these conditions and hold myself bound thereto. I am the owner and the owner of the animal described below and am authorized to make decisions regarding care. Furthermore, I have had the fees outlined and agree to pay all such fees and charges at the time of discharge.

Animal Details

Pet Parents Details
Pet Parents Partner Details
Address
(000) 000-0000
Alternate Contact Name
(000) 000-0000