Drop Off form

Are Vaccinations Current

I am the owner (or authorized agent of the owner) of a pet. I hereby authorize and direct Foothills Animal Clinic, its veterinarians, technicians, and assistants to perform services, procedures, diagnostics, vaccinations, treatments, and/or administration of extra label medications as deemed necessary or advisable in connection with or relating to the matters described in the attached estimate or the matters that have otherwise been explained by Foothills Animal Clinic veterinarians or other Foothills Animal Clinic associates.

I understand that there is a risk of complications with every procedure, including the possibility of death as a severe complication of surgery, anesthesia, or other procedures. I also understand that there is no guarantee as to the results of any procedures, diagnostics, vaccinations, or treatments. I understand that I may ask any questions regarding any procedure, diagnostic, vaccination, or treatment recommended by the Foothills Animal Clinic veterinarian before it is performed.

I understand that there may not be a veterinarian at the hospital at all times. I understand that veterinary technicians or assistants may perform certain functions in the preparation and care of animals even when a veterinarian is not present. I also understand that no staff will be present in the hospital overnight. Unless the veterinarian advises that the animal may remain unattended in the hospital overnight, I will need to take the animal or transfer the animal to a hospital offering overnight care at the end of the day. If I fail to pick up animal before the hospital closes for the day, Foothills Animal Clinic may transfer the animal to a hospital offering overnight care if the veterinarian determines the animal cannot be left unattended overnight. I understand and agree that I am responsible for the payment of any charges of such overnight care.

I agree that hospital staff may walk animals outside. I understand that in the event of an emergency, it may be necessary for the animal to be taken to an emergency hospital. I authorize Foothills Animal Clinic and its veterinarians and other personnel to transport animals to an emergency hospital and to obtain treatment by the emergency hospital to stabilize animals if I cannot be reached. Foothills Animal Clinic and its personnel may disclose such information and records regarding animals to the other hospital as they consider necessary.

I understand that payment is due, in full at the time of services are rendered. I understand it is my responsibility to call the hospital daily, to be updated on my pet, and the costs incurred for medical services during that day. If I do not call or I can not be reached, I understand it is my responsibility to pay what is due.

I understand that Foothills Animal Clinic does not request or require personal information as a condition to payment by credit card, but card users may be required to provide proof of identity. If for any reason payment is not made at the time services are rendered or within 10 days thereafter, I understand that my account may be referred to a collection agency. In the event that my account is referred to a collection agency, I agree that Foothills Animal Clinic may add an amount to my outstanding account balance to reimburse Foothills Animal Clinic for the reasonable collection charge (but not including attorney’s fees) imposed by the collection agency.

If I neglect to pick up an animal within 7 days, Foothills Animal Clinic may assume that my animal has been abandoned and is authorized to make such arrangements as it may deem best.

I understand and agree that portions of my visit or care and treatment of animals may be recorded for educational purposes.