Veterinary Waiver Form

Service Agreement and Acknowledgement of Risks

Client Information:

Pet Owner's Name: [PET OWNER FULL NAME]
Pet's Name: [PET NAME]
Species/Breed: [SPECIES/BREED]
Date of Service: [DATE]

Understanding and Acceptance of Medical Procedures and Risks

As the pet owner or authorized agent for the pet described above, I acknowledge and understand the following:

  1. Medical Procedure Risks: All medical procedures, regardless of their nature, come with inherent risks, including but not limited to complications, unforeseen reactions, or even death.
  2. Information Accuracy: I have provided the veterinary clinic with all relevant information regarding my pet's health, past medical treatments, and any potential risks or concerns.
  3. Decision Making: I grant permission to the veterinarian and their team to make immediate decisions regarding my pet's health if I am not reachable during an emergency.

Liability Release

I, the undersigned, release and hold harmless [VETERINARY CLINIC NAME], its veterinarians, technicians, staff, and other agents from any claims, damages, liabilities, or demands that might arise due to any harm, injury, or incident my pet might experience during the medical procedure or stay.

Client Signature and Contact Details

Participant is Age 18.

Name: Mobile Phone: Email:

*

 

Full Name: ____________________________
Phone: ____________________________
Email: ____________________________
Signature: ____________________________ Date: __________
Emergency Contact Name: ____________________________
Emergency Contact Phone: ____________________________

*Note: This Veterinary Waiver Form is intended as a general guideline. Consultation with a legal expert in your jurisdiction is recommended to ensure its enforceability and compliance with local laws.

By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent

E-Sign Act Disclosure and Agreement

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Hardware & Software Requirements

Use of this Service Requirements

  1. Connection to the internet
  2. Any internet web browser with graphical interface and a pointing device, aka "a mouse" for desktop computers or a touch screen for tablets or modern phones common after 2004
  3. a PDF reader or browser capable of displaying Adobe PDF documents
  4. A printer, should you wish to print and retain a paper copy of signed documents.

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By clicking "Sign & Send" on any document posting to this service, you agree that

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  • Should you desire, you were able to print on paper or electronically save this agreement for future reference
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  • You consent to receive electronically any records, notices, agreements or disclosures made to you by our client, the referring service, during the course of your relationship with that company, subject to revocation per terms above.

Electronic Signature         Disclosure & Consent