I am the owner or authorized agent of the owner of the pet listed above, hereby and direct the veterinarian of this veterinary rehabilitation business or their assistants to perform all rehabilitation assessment and treatments within accepted therapy guidelines as deemed advisable and/or necessary for my pet. I authorize this veterinary rehabilitation business to obtain all medical records regarding my pet as is necessary for the thorough and complete evaluation and treatment of my pet. I understand that portions of my visit may be recorded for educational purposes. I understand that there is no guarantee nor can one be made as to the results or cure of any therapy. I agree to pay, in full, for services rendered. I understand that payment is due at the time services are rendered. If for any reason payment is not made at the time services are rendered or within 10 days thereafter, I understand that my account may be referred to a collection agency. In the event that my account is referred to a collection agency, I agree that this veterinary rehabilitation business may add an amount to my outstanding account balance to reimburse thisveterinary rehabilitation business for the reasonable collection charges (but not including attorney's fees) imposed by the collection agency. In the event of an emergency, or as determined by the veterinarian it may become necessary to take my pet outside the hospital. I authorize this veterinary rehabilitation business to walk, or transport my pet outside of the facility; I understand that this veterinary rehabilitation business will takereasonable precautions to ensure the safety of my pet while in their care. I agree to hold harmless this veterinary rehabilitation business their owners, employees, and agents from any and all liability of any nature, loss or injury to self, loss or injury to family including pet, loss or injury to guest as a result of participating in any assessments, treatments, classes and programs. I personally assume all liability for the care of my pet while under the care of this veterinary rehabilitation business.
