I hereby entrust Smithfield Animal Hospital to care for my pet during their stay. I am the owner, or a representative of the owner, of the animal presented and have the authority to execute this consent and I am at least 18 years of age. I have been advised as to the nature of the procedures to be performed and risks involved. I understand that I must provide phone numbers where the hospital can reach me or a contact person whom I have authorized to make medical decisions.
We anticipate an uncomplicated hospitalization today, but we are prepared for complications if they arise. Sometimes during a hospitalization, we recognize other concerns that need to be addressed or learn the true scope of the problem we are treating. We realized that you may not have planned for these additional services. We must be able to reach you by phone if we find any issues in order to recommend a treatment plan and seek authorization to proceed (cost estimates will be provided). We will make every reasonable attempt to reach you prior to proceeding with any additional services. However, some issues are time-sensitive and provide a narrow window of time in which to reach you. Please list where you or your authorized agent can be reached without delay.
Standard Pickup time is between 3 and 5pm, but due to the nature of hospital operations, actual discharge time may vary. We will contact you after the completion of your pet’s procedures and testing to let you know the earliest that they will be available to pick up. I am aware that there is no overnight monitoring of patients at the hospital. I am responsible for making arrangements for transfer to an emergency clinic should overnight monitoring be recommended.
I understand that payment is due when the patient is released from the hospital.
I have read and understand this authorization and consent.I understand that payment is due when the animal is released from the clinic. I have read and understand this authorization and consent.
