Pet Doctor

This is to certify that I am the legal owner/authorized guardian of the above described pet and I warrant that I have full power of disposition and to contract in regards to the said animal. I hereby give the Veterinarian full and complete authority while the animal is under his care, to treat or do whatever is necessary for the said animal and it is expressly understood that whatever may be the result thereof I shall hold nobody liable or responsible thereto and, I hereby fully and absolutely relieve the Veterinarian, the Pet Doctor Veterinary Clinic, Pet Doctor Dog and Cat Health and Wellness Center and its staff of any and all liabilities. Furthermore I accept all financial responsibilities concerning all medical charges of the said animal. In witness whereof, I hereunto sign this agreement to take effect from the date stated below and thereafter.

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Signature over Printed Name of Owner/Guardian Present Date