Check-In & Authorization Form

I, the undersigned owner or agent of the owner for the pet identified above, certify that I am eighteen years of age or older and authorize the veterinarian(s) and designated staff members of Trinity Veterinary Medical Center to examine, perform diagnostic testing, administer medications, and/or treatments on my pet as deemed necessary by the attending veterinarian.

I understand that I will be provided with an estimate for the cost of services above and beyond the initial examination fee. I understand that I have the right to ask about possible alternative procedure(s) and/or treatment options prior to signing an estimate. In the event that my pet requires hospitalization, I understand that a deposit of 50% of the high end of the estimate will be required. I understand that any additional fees for services approved after the initial estimate will be due when the pet is discharged from the hospital. I understand that if the deposit is not used, I may receive a refund.

I understand that there may be pros and cons associated with the recommended procedure(s). I am aware that I am encouraged to discuss any concerns I may have regarding the recommended procedure(s) with the attending veterinarian before the procedure(s) is/are initiated. I am aware that if any questions arise from me, I am encouraged to call Trinity Veterinary Medical Center to speak with a staff member regarding my questions.

I understand that Trinity Veterinary Medical Center's hours of operation are Monday through Friday, 8:30 AM to 5:30 PM, and Saturday, 8:30 AM to 1:00 PM. I understand that if continued hospitalization is recommended, it is my responsibility to make arrangements for my pet to be transferred. I understand that, after 48 hours without communication with Trinity Veterinary Medical Center, my pet will be considered abandoned, and the proper course of action, per the law, will be taken.

Full payment is expected at the time of services rendered. No financing directly from Trinity Veterinary Medical Center is available. I understand that if my pet is admitted to the hospital then 50% of the estimate high end is required at time of admittance. I also understand that if my pet receives outpatient care (care performed then the pet is sent home) then payment is due before my pet is discharged and before I leave the building.