• I am the owner (or authorized agent for) of the above-mentioned animal.

    I have discussed the reasons for hospitalization and I am satisfied with the plan of management. The nature of such services has been described to me to my satisfaction and I realize that neither guarantee nor warranty can ethically or professionally be made regarding the results or cure. I authorize use of sedatives and pain medications if deemed warranted. If anesthesia or sedation is required, I understand, and accept that there are always inherent risks, including death. I also authorize the clinic staff in an emergency situation, to follow through with such procedures as are necessary for the well being of my pet on a continuing basis until further communication with me is possible.

  • for anticipated medical services. It is understood that there may be unforeseen complications and that further treatment may be necessary during the hospitalization. I accept and assume full and total financial responsibility for any and all services rendered by the clinic, its staff or employees in the treatment of the above described animal and agree to pay the fees at the time of my pet’s discharge or other demise.

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  • Please ensure that your designated agent is aware that you have given us his/her name, and is willing and able to make decisions regarding the care and well-being of your cat.

    Any cat not claimed within ten (10) days of pick-up date, without new provisions being made, will be considered abandoned, and becomes our property and will be handled according to our best judgment.

  • Your must bring all medications in their original containers. If medications are not provided, you will be charged at the current rates.

    Please list any/all medications below, their dosages and instructions

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  • Special Instructions (please initial each line that applies)

    Unless otherwise instructed your cat will receive Hill’s Science Diet. If your cat has other dietary needs, please provide the food or allow us to provide it at current charges.

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  • The undersigned hereby warrants that they are the owner or authorized agent for the cat listed in this record and does consent and authorize our staff to care for and treat said cat. If an emergency situation arises, I authorize services, including the use of anesthesia if necessary, to treat my cat until such time as I can be contacted. I understand that every reasonable effort will be made to contact me as soon as possible if an emergency or unanticipated situation arises with my cat. If I am unable to be reached, I authorize the veterinarians to proceed with treatment as deemed necessary for the well being of my cat. I understand I will be responsible for all charges incurred at checkout.

    If I have requested that medical, surgical, dental, or other services be performed for my cat while it is residing in the boarding kennel, I consent to and authorize our staff to perform diagnostic, therapeutic, anesthetic, emergency, and surgical procedures as are necessary and advisable for the treatment and maintenance of my cat’s health and well-being. I understand that with any procedure or treatment that there are risks that may not be predictable, including death, and I accept these risks. While I expect all procedures to be performed to the best of the abilities of the staff, I acknowledge that no guarantee or warranty regarding the outcome or results of any treatment has been given. I acknowledge that hair may be shaved or clipped as necessary to facilitate treatment. I expect that reasonable precautions will be used to ensure my cat’s safety and well-being while in our care, and I agree to pay in full for all services provided at the time of discharge. I understand that if an unanticipated need for additional procedures or services (e.g. extractions of teeth, biopsies of abnormal tissues, etc.) occurs, a reasonable effort will be made to contact me using the contact information provided above. I understand that if I cannot be contacted, that non-emergency procedures or services will not be performed, at that this may mean that my cat may need to have another procedure at a future date at my expense.

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  • As owner, or agent for the owner, of the animal, I hereby consent for humane euthanasia to be performed. I further authorize the attending veterinarian to care for the remains in accordance with hospital policy (cremation) and my request below. To the best of my knowledge and belief, this animal has not bitten anyone in the ten days preceding this date.
  • CLAY PAWS MUST BE MADE AT TIME OF SERVICE
  • Unless otherwise requested remains are returned in a fiber container or velour pouch and should be ready in 10 to 14 days. You will be notified when they are ready for pickup.
  • Payment due at time of service
  • Remains will be held for 1 year from the date they are ready for pickup unless other arrangements are made in advance.

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  • Please be aware it may take up to 24hours to hear from us with the results.
  • Problem give details:

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  • I am authorizing Evergreen Animal Hospital to perform the surgical procedure listed in the signed estimate. All of the above information is complete and accurate.

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Ever green vet Form

Please Fill out everything
  • Please fill out everything

  • Emergency contact information

  • If you have a family veterinarian other than Evergreen Animal Hospital, I understand treatment records will be forwarded to the named veterinarian and by signing this authorization I hereby give permission for my pets records to be released.
  • Treatment Authorization & Information

  • I hereby authorize Evergreen Animal Hospital to perform medical and diagnostic/surgical procedures on my pet as required for diagnosis and treatment. I understand that I can terminate treatment at any time by contacting the doctors or technicians.
  • I do hereby grant EAH and its assigns representatives the right to use my pet's photo and images for advertising, facebook, website etc.
  • How did you find us?

  • PLEASE NOTE: Current Drivers License # is needed for payment by check or credit card. We cannot accept out of state or post dated checks.
  • Financial Policy

    We offer Care Credit, an outside lending service, if payment can't be made at time of service. Ask if needed

  • Payment Is Due In Full As Services Are Rendered.

  • I understand that I, as the owner or agent, am financially responsible for the applicable Evergreen Animal Hospital charges relating to the treatment my pet(s). I have read and agree to the treatment authorization. I have also read and accept the financial policy.
  • Pet Emergencies When The Owner Isn't Available For Direction

    I do hereby grant Evergreen Animal Hospital and its assigns, licensees, and legal representatives the irrevocable right to use my and my pet(s) photograph/image for advertising, or any lawful purpose, and I waive my right to inspect or approve the product.
  • Thank You For Allowing Evergreen Animal Hospital To Provide For Your Pets Health Care Needs