• MM slash DD slash YYYY
    This is required for controlled medication.
  • NameBirthdateSpeciesBreedColorGenderSpayed/Neutered 
  • Please read carefully before signing

  • I understand that professional fees are to be paid in full at the time services are rendered.

    I authorize San Carlos Animal Hospital to provide medical services for my pets.

    I, the owner or authorizing agent of the patients described above, assume full responsibility for all charges incurred regardless of the outcome of the patients’ treatment.

    In the case of an emergency I authorize San Carlos Animal Hospital to start life-saving procedures.

  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.