Name: Abbey Animal Hospital
Address: 1949 Lynnhaven Pkwy #1524, Virginia, VA23453
Telephone: +1-(757) 471-1003
Price range: $$

I hereby authorize Abbey Animal Hospital to receive and provide care for my pet*
(Pet's Name)
I understand that all precautions will be taken to ensure the safety and the health of my pet during his/her stay.

I also understand that every attempt will be made by the doctors and staff to notify me prior to additional medical treatment or cost.
I (DO or DO NOT) authorize Abbey Animal Hospital to perform the necessary procedures for my pet at our discretion. I assume full responsibility for all medical expenses incurred during my pet’s stay.*
- DO
- DO NOT
If authorizing treatment, I authorize up to ____ for treatment costs.*
(Max Amount Authorizing)
Initials
For pets needing sedation, I understand that all anesthesia involves some risk to my pet including (very rarely) death and unforeseen complications.*

For pets needing sedation, I understand that all anesthesia involves some risk to my pet including (very rarely) death and unforeseen complications.
To prevent the spread of infectious diseases and parasites, ALL OWNERS MUST PROVIDE PROOF OF ALL VACCINES AND BE FREE OF ALL INTERNAL & EXTERNAL PARASITES INCLUDING FLEAS. I AUTHORIZE THE DOCTOR TO UPDATE ANY REQUIRED VACCINES AND TESTS, IF I FAIL TO PROVIDE PROPER PROOF. PARASITE CONTROL WILL BE PROVIDED AS NEEDED FOR MY PET AT MY EXPENSE.*

To prevent the spread of infectious diseases and parasites, ALL OWNERS MUST PROVIDE PROOF OF ALL VACCINES AND BE FREE OF ALL INTERNAL & EXTERNAL PARASITES INCLUDING FLEAS. I AUTHORIZE THE DOCTOR TO UPDATE ANY REQUIRED VACCINES AND TESTS, IF I FAIL TO PROVIDE PROPER PROOF. PARASITE CONTROL WILL BE PROVIDED AS NEEDED FOR MY PET AT MY EXPENSE.

I have requested the following procedure(s) and/or treatment for my pet:

I have read all the above information and I understand and accept all the risks and responsibility involved.*

I have read all the above information and I understand and accept all the risks and responsibility involved.
I understand that to ensure a flea-free environment, should any fleas be found on my pet, Abbey Animal Hospital will give a capstar in house and I understand that additional costs may apply.*

I understand that to ensure a flea-free environment, should any fleas be found on my pet, Abbey Animal Hospital will give a capstar in house and I understand that additional costs may apply.
Phone*
2nd Contact
Signature*
Date*
MM slash DD slash YYYY

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