Healthcare Vet Clinic Contract

HEALTHCARE VET CLINIC CONTRACT

This Veterinary Services Agreement ("Agreement") is entered into between Clinic Name: and Client Name: with an Effective Date of .

Owner / Client Information

Patient (Animal) Information

Insurance / Billing Information

Medical History

Consent for Treatment, Diagnostics and Surgery

I, the undersigned owner or authorized agent, authorize the clinic, its veterinarians and staff to examine, prescribe for, diagnose, perform procedures on and treat the animal identified above. I understand that no guarantees have been made as to the results of treatments or procedures.

I acknowledge the risks and benefits of recommended diagnostic and treatment options, including but not limited to infection, hemorrhage, anesthetic complication and unforeseen adverse reaction. I understand that anesthesia carries risk and may be necessary for certain procedures.

Authorizations (check as appropriate):
I authorize routine diagnostics and treatments as indicated.
I authorize surgery and associated anesthesia if recommended.
I authorize the use of general and/or local anesthetics, analgesics and sedatives as deemed necessary.
I authorize pre-anesthetic bloodwork and intra-operative monitoring as recommended.
I authorize implantation of a microchip if recommended.
I authorize routine vaccinations recommended during this visit.

Emergency treatment authorization: If the clinic determines that immediate treatment is necessary to prevent death or serious deterioration, and reasonable attempts to contact me are unsuccessful, do the following:
Proceed with emergency treatment up to $ . If an estimated total exceeds $ , do not proceed without my further consent

Payment, Fees and Estimates

The owner agrees to be financially responsible for all charges incurred for services rendered to the animal. Payment in full is due at the time services are rendered unless prior written arrangements are made. I understand that estimates are approximate and additional charges may apply for unforeseen conditions.

If account remains unpaid, owner is responsible for collection and legal fees. The clinic may retain possession of the animal until all charges are paid and may, after days of written notice and failure of owner to respond, deem the animal abandoned and dispose of it in accordance with clinic policy and applicable law.

Release of Records and Privacy

Veterinary medical records are the property of the clinic. Release of records to third parties requires written authorization from the owner. I authorize release of records to:

Representations, Warranties and Liability

Owner represents that the information provided is true and complete to the best of their knowledge. Owner agrees to notify the clinic of any changes in the animal's health status. The clinic will exercise reasonable professional care; however, the clinic is not responsible for unforeseeable complications or adverse reactions. To the extent permitted by law, the clinic's liability for damages arising out of treatment shall not exceed the total amount paid by the owner for the services giving rise to the claim.

By signing below, the owner acknowledges that they have read, understand and accept the terms of this Agreement, consent to the treatments authorized herein, and agree to be responsible for payment of all charges incurred.

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