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Home
Updates Regarding COVID-19
Our Services
>
Internal Medicine
Dental Care
Diagnostic Medicine
Wellness Exams
Surgery
Grooming, Boarding & Day Care
Hospice & Euthanasia
Pharmacy & Pet Supplies
Office Visits
>
Wellness
>
Pet Care Plan
Flea, Tick & Heartworm
Behavioral Medicine
Exams
Vaccinations
House Calls
Emergency Care
Microchipping
Covid 19 - Pandemic
Our Staff
Doctors
Client Center
ONLINE STORE
Client Forms
>
Anesthetic Release Form
Boarding Release Form
Consent For Treatment
Drop Off Form
Euthanasia Consent Form
New Client Form
Helpful Pet Links
Petly
Downloads
Client Reviews
Contact
Treatment Consent
*
Indicates required field
Name
*
First
Last
Pet's name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Pet's Age
*
Pet's Gender
*
Intact Male
Intact Female
Neutered Male
Spayed Female
Breed
*
Color of Coat
*
Email
*
I hereby authorize the following:
*
Lab Work
X-Rays
Hospitalization
Other
Other
*
I, the undersigned, certify that I am the owner, or authorized agent for the owner, of the pet described above. I authorize the doctor and assistants to perform the procedure(s) listed above, including administration of pain relief medications, sedatives, and/or anesthetics, as well as any necessary medical, radiological, surgical, nursing, diagnostic, and/or emergency care for the pet. I have been advised as to the nature of the procedures and the potential risks. I also understand that no guarantee of successful treatment can be made and assume full financial responsibility.
I agree to hold Cheyenne West Animal Hospital harmless, in the absence of negligence, from and against any and all liability arising out of the performance of any of the procedure(s) referred to above. I have been informed that Cheyenne West Animal Hospital is not staffed 24 hours a day. I understand that if my pet requires overnight supervision post-surgically, or hospitalization, my pet will be referred to the appropriate emergency hospital.
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