I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above
described pet(s). I assume full responsibility for all charges incurred for the care of this
animal. I also understand that these charges will be paid at the time of release and that a
deposit may be required for surgical treatment. I further agree to be added to the clinic's MyVetStore as a client of Animal Hospital On Bell Farm Road, at submission of new client forms.