Waivers

Consent to Treat My Pet

I, the undersigned owner, agent of the owner, or Good Samaritan responsible for seeking veterinary care for the pet identified as above, certify that I am 18 years of age or older. I consent to the examination and treatment of my pet by Simonson Veterinary Services. I also agree that after consultation with me, Dr. Simonson may prescribe medications for, do diagnostic testing on, or perform treatments for my pet. I understand that some risks always exist with veterinary medical care and I am able to discuss any concerns I have prior to treatment proceeding.
I understand I am encouraged to discuss all fees related to my pet’s ongoing medical treatment. I agree to assume financial responsibility for all fees incurred during the care of my pet and will provide payment via cash, credit card, or check.
I realize that no guarantee has been made or implied regarding results or cure.

Acupuncture Waiver

Client Consent Required. Before acupuncture may be used in the treatment of an animal, the veterinarian must obtain a signed statement from the animal's owner or caretaker acknowledging that acupuncture is an alternate therapy in veterinary medicine and approving its use in the treatment of the animal. Before signing the statement, the veterinarian shall inform the client of the conventional treatments available and their probable ability to cure the problem. The statement shall become a permanent part of the patient's record.

Consent for Euthanasia

I certify that I am the owner of or person responsible for the animal described above. I give the doctor complete authority to perform euthanasia for this animal in whatever way she recommends.

I understand the animal will be treated humanely. I release the doctor from any liability for performing euthanasia for this animal

I certify that this animal has not bitten any person or animal in the past 15 days and to the best of my knowledge has not been exposed to rabies.