New Client Form

• I request that the doctors and staff at West Palm Animal Clinic perform the services which are necessary to the examination and medical treatment of the animal(s) presented by me. I am the owner or agent for the described animal(s) and have authority to execute this consent.

• I authorize the veterinarian on duty (and assistant they may designate) to examine the animal(s) and to administer the examination findings. I therefore, hereby consent to and authorize the performance of such procedures as deemed necessary and desirable in the veterinarian’s professional judgment.

• I understand that the treatment of the patient(s) will be conducted with due care and in accordance with the prevailing standards of care in veterinary medicine. I certify that no guarantee or assurance has been made as to the results that may be obtained through the course of treatment undertaken by the provider.

• I agree to pay all attorney’s fees, finance charges, collection cost and other cost of litigation incurred in the collection of past accounts.

• I understand that a written estimate for charges will be provided at my request. I also consent to the release of medical information.

• I assume the responsibility for all charges incurred to the patient for services rendered and understand that full payment is required upon request.