Treatment Authorization Form

Thank you for choosing us as partners in the care of your pets. Our doctors and staff look forward to working with you towards a lifetime of health and happiness for your furry family.
Please take a few minutes to fill in the requested information below:

Name *

Email *

Cell Phone *

Work Phone

Home Phone

Which phone is your primary contact number? *

Cell
Work
Home

Authorized person to make decisions in your absence (other than spouse / co-owner) *

Name

Authorized Person Phone Number *

I authorize AMC of Garner Veterinary Hospital, its doctors and staff, to administer such treatments and to perform such procedures that are considered therapeutically and diagnostically necessary for the care of my pet. *

In the event that emergency treatment is required and I cannot be reached: *

I authorize the doctors and staff to perform such medical and surgical treatments as is necessary to preserve the life of my pet until I can be contacted. I understand that no guarantee of successful treatment can be made.
I DO NOT authorize the doctors and staff to perform such medical and surgical treatments as is necessary to preserve the life of my pet until I can be contacted.

Anesthesia may be required for surgical, dental and some medical procedures. AMC of Garner will take every precaution to ensure a safe outcome. This will include pre-anesthetic examination, recent pre-anesthetic lab work and individually tailored anesthetic protocols. Pre-anesthetic lab work includes an organ chemistry panel, complete blood count and electrolytes panel, and is required to undergo anesthesia. I understand that despite these precaution there is inherent risk with anesthesia which could lead to complications. *

I accept financial responsibility for the treatment of the above named patient and understand that payment is due in full upon release from the hospital or when the services are otherwise terminated. I realize that in many cases it is impossible to determine the full extent of treatment required. Cost of services discussed prior to treatment are estimates. Actual costs may be higher or lower than estimates provided. *

I acknowledge that AMC of Garner Veterinary Hospital is staffed during the following hours and staffing during other hours is intermittent: Monday-Friday: 7:30 AM-6:00 PM and Saturday: 8:00 AM-12:00 PM *

I have read and understand this form: *

Digital Signature *

Date *

Website

Modern Medicine, Like Family.

Online Pharmacy

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Hours

Monday-Friday: 7:30am – 6:00pm
Saturday: 8:00am – 12:00pm
Sunday: Closed

Contact Info

Phone: (919) 779-8887 (Call or Text)

Email: reception@amcofgarner.com