I am the owner or authorized agent of the pet presented to Advanced Veterinary Internal Medicine. I am of legal age and I consent to the administration of emergency medical treatment for my pet in the best judgment of the veterinarian should the need arise. I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above described pet and provide any pertinent medical records to other Veterinarians or medical professionals involved in my pet’s care unless requested otherwise. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid when services are rendered and that a deposit may be required for treatment. If for any reason payment is not made, I agree to interest charged annum, necessary attorney’s fees, court costs and late fees and any other recovery fees.

Pacific Care Pet Emergency & Specialty requests permission to use information for internal and external use such as: research, education and social media. I authorize the use of my pet’s first name, photograph and clinical information (including at times medical condition, treatment and prognosis). Under no circumstances will my name, my personal or financial information be shared through these sources.