Client Check-In Form

I hereby authorize Animal Emergency of Pasco, it’s representative, agent or employees, to perform services and/or surgery on the above described animal, and do hereby release and forever discharge Animal Emergency of Pasco, it’s representative, agent or employees, from all claims and demands whatsoever which I have or may have against Animal Emergency of Pasco, it’s representative, agent or employees, by reason of said surgery, administration of drugs or performance of other services, and any consequences resulting directly or indirectly there from.

I further certify that I am at least 18 years of age, and have ordered, or have been authorized to order, the services for the above described animal. In any event, I accept full financial responsibility for the payment of services ordered and rendered.

I understand that any animal not called for within 3 days of the date that the hospital shall designate for its release shall be considered abandoned by me, and shall be disposed of at the discretion of the hospital.

Financial responsibility shall not in any way be altered by such disposal and my indebtedness shall include all charges made against such animal up to and including the date of, charges for and disposal of same.

Should it become necessary to collect this account through an attorney, the undersigned agrees to pay all costs of collection, including reasonable attorney’s fees. I also understand that there is an office exam fee due upon examination of the above described animal and that this fee is to be paid whether or not the animal receives medical treatment.