TERMS OF SERVICE: 

By submitting this form, you are authorizing Southwood Veterinary Hospital, and whomever they may designate as their assistants to administer such treatments and procedures as are therapeutically and/or diagnostically necessary as indicated by findings during medical evaluation. All treatments will be discussed prior to procedures being administered unless deemed a lifesaving procedure.

 

You certify that you have read and fully understand the above AUTHORIZATION FOR MEDICAL TREATMENT. You also certify that no guarantee or assurance has been made regarding the results that have been obtained. Further, you assume financial responsibility for all charges incurred to the patient. You understand that Southwood Veterinary Hospital does not accept cheques, but Visa, Mastercard, Interact, and cash are welcome.  

 

You authorize Southwood Veterinary Hospital to, it's Veterinarians and associates to access personal information and pet's medical history. You understand any release of this information requires your signature and personal authorization, with the exception of an emergency situation that threatens life, health or security of an individual and / or their pet(s) or communication between the Southwood Veterinary Hospital and an Animal Authority Association (Humane Society, Animal Services, The Society of Prevention of Cruelty to Animals). A copy of the Southwood Veterinary Hospital Privacy Policies and Procedures is available for your review at any time. 

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