Day Admission Consent Form

Please complete the form below and submit it to us in advance of your appointment.

**All patients must be checked-in to the hospital before 9:00 AM**

Day Admission Consent Form

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Unless emergent, all day admissions are seen between 11:00 a.m. and 3:00 p.m. We will call as soon as your pet has been examined to discuss our findings and tell you when your pet can go home. Patients in the hospital for baths will be available to go home after 3:00 p.m. to allow for your pet to be thoroughly dried and brushed before going home.
  • IF MEDICALLY NECESSARY, DO WE HAVE PERMISSION TO:
  • Please provide your initials indicating your preference for the above selections.
  • I am the owner or agent of the above described animal, I am at least 18 years of age, and I have the authority to execute this consent. I understand that Shackleford Road Veterinary Clinic requires my pet to be free from internal and external parasites and up to date on all vaccinations. I am financially responsible for all medical procedures and treatments, as well as for any cost associated with vaccination or parasite treatment and that this payment is due upon discharge. I understand that during the performance of the aforementioned medical procedure(s) and treatment(s), unforeseen conditions may be revealed that necessitate an extension of the aforementioned medical procedure(s) and treatment(s) than those set forth above, which may result in a change in the estimated cost. Therefore, I hereby consent to and authorize the performance of such medical procedure(s) and treatment(s) as are necessary and desirable in the exercise of the veterinarian's professional judgement. I also authorize the use of appropriate anesthetics and other medications and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised of the nature of the medical procedure(s) and treatment(s) and the risks involved. I realize that results cannot be guaranteed. I have read and understand this authorization and consent. I hereby consent I authorize the veterinarians and staff of Shackleford Road Veterinary Clinic to render treatment, and by signing below agree to all conditions. I certify that if I am signing as owner/agent, that I have the authority to execute this consent.
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Request an Appointment

LET’S GET STARTED