Please note: All pets undergoing sedation must be free of external parasites. If fleas, ticks, or ear mites are found, the pets will be treated for these parasites at the owner’s expense. Likewise, animals unvaccinated or overdue for Rabies immunization will be vaccinated as an additional expense.
I, being the responsible party for the above animal, authorize the performance of the procedure(s) outlined above by the professionals and staff at Mainstay Veterinary Practice. I understand that sedation always involves some amount of risk and that during the performance of this/these procedure(s), unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above.
I expect Mainstay Veterinary Practice to use reasonable care and judgment in performing the procedure(s) to the best of their abilities. I realize that no guarantee or warrantee can ethically or professionally be made regarding the results or cure. I am also aware that unforeseen complications resulting from the procedure(s) will not relieve me from any obligations to all reasonable costs incurred regarding the animal.
I hereby authorize the veterinarian to examine, prescribe for, or treat the above named pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of my pet’s release.
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3083 Nutley Street
Fairfax, VA 22031
Phone: (703) 280-4588
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