Anesthesia / Surgical Consent

I, the undersigned owner or agent of the pet identified above, authorize the staff of Adamstown Veterinary Hospital
to perform the above procedure(s).

I understand that some risks always exist with any anesthetic, medical, or surgical procedure (including serious
bodily injury or death), and that I am encouraged to discuss any concerns I have about those risks with the attending
veterinarian before the procedure is initiated. I also understand that performing a procedure does not guarantee
results. Should some unexpected, life-threatening emergency arise and I am unable to be reached, I give my
permission to the veterinarians and staff to provide the necessary treatment to preserve my pet's life until I can be
reached, and I agree to pay for such care. I understand that the veterinarians and staff will use all reasonable
precautions against injury, escape, or death of my pet, but will not be held responsible in any matter, as it is
thoroughly understood that I assume all risks.

I understand that an estimate of the costs for veterinary services, in the absence of a specific written agreement to
the contrary, will be provided to me upon request and that I am encouraged to discuss all fees attendant to such
care before services are rendered and during my pet's ongoing treatment, not withstanding such estimates and
realizing that treatment may change, and I agree to assume financial responsibility. I agree to pay in full for all
services on a cash, credit card or check basis at the time of discharge from the hospital. In the event of an open
balance, any such balance will be assessed a monthly billing and finance charge of 1.5% monthly, which is 18%
yearly.

I agree that either I or an authorized agent of mine will pick up this pet and pay for all accrued charges at the time of
discharge,unless prior arrangements are made with hospital management. Failure to do so may be considered
abandonment and Adamstown Veterinary Hospital shall deal with this abandonment in a manor consistent with the
best interests of the hospital and the pet. I understand that this would not relieve me from any financial responsibility
previously incurred.