Wellness Release | WCVC

top of page

CENTRO VETERINARIO COMUNITARIO DE WISCONSIN (1).png

Hogar
Acerca de
Servicios
Contact
- Contacto
- Realizar un pago
Cronograma
Farmacia en línea
Recursos
New Page
New Page
- New Page
More

Use tab to navigate through the menu items.

Wellness Release

Owner/ Authorized Agent

Address

City

State

Zip

Phone

Pets Name

Breed

Species

Email

Age

Sex * Obligatorio

M

F

Weight

Spayed/Neutered? * Obligatorio

Yes

No

Color

Do you have a regular Veterinarian? * Obligatorio

Yes

No

If yes, please list

Purpose of Appointment:

Additional Appointment Details

AUTHORIZATION & CONSENT

I request and authorize Wisconsin Community Veterinary Center (WCVC) to vaccinate the above described animals, if indicated as necessary.

I understand that vaccines may cause adverse reactions in some animals, such as a severe allergic reaction or cancer. I hereby release WCVC & it’s employees & volunteers from any claims arising from or connected with any vaccines received today.

I certify that; a.) my animal is current on all recommended vaccines, b.) I am updating overdue vaccines today, or c.) I am waiving the right to protect my animal by choosing to not vaccinate. I understand the inherent risk of failing to maintain current vaccines and waive all claims arising from or connected to this choice.

I certify that my animal is in good health, or I have disclosed all health concerns to the Veterinary staff at WCVC

I understand that WCVC has the right to refuse services to any animal to whom it is deemed a health risk.

I understand that emergency procedures will be attempted if complications arise; these may result in additional charges.

I understand that if my animal is not picked up by the designated check out time, I will be responsible for boarding and overnight care charges. If I do not claim my animal within 5 business days, my animal will become property of the clinic.

I agree to pay for charges incurred today, as well as any aftercare. Unposted charges: In some instances, charges for services rendered may still be in the processing stage when animal is discharged. I agree to pay for charges once a final bill is received.

I hereby release WCVC (SFTS), any employee, or any volunteer from any and all claims arising from the procedures performed today.

By signing below, I verify that I have no questions for the receptionist checking me in.

Date * required

Thanks for filling out the authorization form in advance.

CONTÁCTANOS

4475 Robertson Rd

Madison, WI 53714

Teléfono: 608-224-1400

recepción@wicvc.org

SITIO WEB DE RESCATE DE SFTS

CONECTA CON NOSOTROS

Facebook

Instagram

HAGA UNA DONACIÓN

SUSCRÍBETE AL BOLETÍN

ENLACES RÁPIDOS:

Vea nuestros servicios

Solicite una cita

Vídeo sobre el consentimiento informado

Inscripción para la teleconferencia

Cuidados postoperatorios

WCVC es una clínica veterinaria de servicio completo, sin fines de lucro, ubicada en Madison, Wisconsin.

© 2024 Centro Veterinario Comunitario de Wisconsin

bottom of page