Full Name *

Address

Email *

Phone *

Are you over the age of 60? *

Name *

Phone *

Address *

I HEREBY CONSENT FOR THE ABOVE PERSON TO ACT ON MY BEHALF FOR THE TREATMENT, INCLUDING FINANCIAL CONSENT, OF ANY OF MY PETS.* *

Pet Name *

Date of Birth *

Age *

Sex *

Colour *

Spayed (female) Neutered (male) *

Microchipped? *

Check the conditions that apply to your pet:

Which preventative care procedures are you approving?

Has your pet experience this condition in the past?

If YES how long has this condition been going on for, and with what frequency?

Briefly list any symptoms your pet is experiencing, along with when this symptom started

Has your pet ever had a reaction to vaccines? *

Are there any other issues or concerns that you would like to discuss at your appointment?

I authorize "Creditview Eglinton Animal Hospital " to do whatever is necessary should an emergency arise. Should my pet become ill or injure itself, and Truscott Animal Hospital is unable to contact me or my emergency contact at the phone numbers provided, my pet will be treated as deemed necessary by the attending DVM at my own expense.