"*" indicates required fields

Owner's Name*
I am over 18 and understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, I agree that In the event my pet experience a cardiac, respiratory or other life-threatening emergency that requires resuscitative or other urgent care measures, such as cardiopulmonary resuscitation (CPR), positive pressure ventilation, emergency drugs, or other similar measures, I request that the veterinarians and/or trained staff at Memorial Veterinary Clinic pursue such medical care as indicated below.*
I hereby certify that I have read and fully understand this authorization for sedating my pet at Memorial Veterinary Clinic, and I assume financial responsibility for all charges incurred to the above pet(s) and agree to pay all such charges at the completion of this stay.
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This field is for validation purposes and should be left unchanged.