RELEASE PATIENT AGAINST DOCTOR’S RECOMMENDATIONS

RELEASE PATIENT AGAINST DOCTOR’S RECOMMENDATIONS
OWNER/LEGAL GUARDIAN'S INFORMATION
Owner/Legal Guardian*

First NameLast Name
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
PET INFORMATION
Pet Name*
Pet Species*
Pet Breed*
Pet Color*
Pet Age*
Pet ID Markings*
Tattoo, Microchip, Rabies Tag, Etc
I, the undersigned owner or agent for the owner, acknowledge that because of the serious medical condition of the animal identified above, Paws and Claws Medical Center recommends that my animal be/remain admitted and/or hospitalized for further diagnostic procedures, monitoring and/or treatment.

I hereby request that my animal be released to me in spite of the nature of its medical condition and I fully recognize that this release is against doctor’s recommendations.

I understand that my animal needs further medical attention and that it is my responsibility to seek such further care at the veterinary facility of my choice. In the event any adverse medical problems occur to my animal because of my decision to remove it from Paws and Claws Medical Center, I accept full financial and medical responsibility for my decision to remove my animal from Paws and Claws Medical Center and its staff of all responsibility for my decision.
Signature*

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