Veterinary Recommendations Waived Form

Fill Out Our Veterinary Recommendations Waived Form

Please check the box(es) that correspond to the clause(s) below (1, 2, or 3) that apply to your situation and your pet’s care decision. *

1. DECLINED RECOMMENDED TREATMENT: do hereby acknowledge that the above facility has offered me a treatment plan for my pet’s presented condition and I have refused this option against the advice of the vets and staff of this facility and that I do so entirely at my own risk.
2. SPECIALIST REFERRAL: do hereby acknowledge that the above facility has offered me a referral of my pet to a specialist facility and I have refused this option against the advice of the vets and staff of this facility and that I do so entirely at my own risk.
3. HUMANE EUTHANASIA: do hereby acknowledge that the above facility has offered me euthanasia for my pet and I have refused this option against the advice of the vets and staff of this facility and that I do so entirely at my own risk.

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I, the undersigned, do hereby unconditionally indemnify this facility and the staff of this facility against any claim of whatsoever nature arising from any claim of unprofessional conduct, negligence or for damages in any form whatsoever.

I acknowledge that I have read and understood these conditions and hold myself bound thereto.

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Signature (Owner/Responsible Party) *

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Veterinary Recommendations Waived Form

Fill Out Our Veterinary Recommendations Waived Form

Details of Patient

Details of Owner or Authorized Agent

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