Drop Off ConsentConsent for Evaluation and Treatment of Pet in the care of WWVCReason for Visit (select all that apply)(Required) Wellness Exam / Vaccines/ Testing Sick / Not Feeling Well Procedure / Diagnostics Injury / Wound Care Other Reason for Visit Eye /Ear / Skin IssueDescribe Concerns(Required)Additional Services Requested Medication Refill Prevention Refill Nail Trim Anal Glands Diagnostic TestsList medications/prevention refills needed OR additional services requested(Required)Authorization for Examination and Treatment(Required) I, the undersigned owner or authorized agent of the above-named pet, give my consent for the veterinarians and staff at Walton Way Veterinary Clinic to perform an examination and any necessary diagnostics or treatments as deemed appropriate for my pet’s current condition.I understand thatA veterinarian will examine my pet as soon as possibleI will be contacted to discuss recommended diagnostics, treatments, and estimated costs before any additional procedures are performed (except in life-threatening emergencies).I agree to pick up my pet at the scheduled discharge time, and understand additional fees will accrue if delayed.I agree to be readily available by phone while my pet is in the care of WWVC at the number(s) provided:Phone Number (s) where I can be reached todayBest phone number to reach you(Required)Alternate phone numberIf I am unreachable, I authorize the veterinarians to perform the following (please check ONE)(Required) Only perform an initial examination, then call me for further consent. Perform any diagnostics and treatments necessary for the health and comfort of my pet, up to initially estimated rangeOther InstructionsSedation Consent (If Needed)(Required) I authorize Walton Way Veterinary Clinic to administer sedation to my pet only if it is deemed necessary for diagnostics, procedures, or the comfort and safety of my pet and the staff. I understand that sedation will only be used when appropriate and that the safety of my pet, including the risks and benefits will be considered by the veterinary team.Sedation Authorization (If needed)(Required) No Sedation Authorized – I understand some procedures may not be able to be completed during this visit Sedation Authorized (only if required) Contact me before proceeding with sedativesMedical History & MedicationsIs Your Pet Currently Taking Any Medications?(Required) No Flea/Tick/Heartworm Prevention Only Other MedicationsPlease List(Required) Add RemoveTime of Last Dose(Required) Hours: Minutes AMPM AM/PMAny Known Allergies or Reaction to Previous Medications(Required) No YesIf yes, Please describe(Required)Consent & Financial Responsibility I understand that payment is due in full at the time my pet is discharged. I accept financial responsibility for all charges incurred during my pet’s stay and treatment.SignatureΔ
