Release for Medical Treatment
I, the undersigned, do hereby certify that I am the owner, or duly authorized agent for the owner, of the animal described above and that I do hereby give Georgetown Veterinary Hospital, its veterinarians, agents and/or representatives full and complete authority to perform the dental procedure prescribed above. I also grant permission to perform any other procedure that, at her discretion, may be useful to promote health of the above described pet, and I do hereby and by the presents forever release the said doctor, her agents or representatives from any liability arising from said dental/surgical procedure on said animal. I accept full financial responsibility for all tests and treatments that I verbally authorize during my conversation with the doctor. I understand that payment is due in full when my pet is discharged.
I understand that if evidence of fleas is found on my pet during the examination, a dose of CAPSTAR will be administered at my expense. (Approximately $8)