PATIENT INFORMATION
REQUIRED Avian Procedures/Testing (please provide most recent dates)
REQUIRED Mammal Procedures/Testing (please provide most recent dates)
Digital Signature
I hereby give consent to Ness Exotic Wellness Center to provide boarding services for my pet(s) from the dates indicated above. I understand that unforeseen conditions may require a medical or surgical procedure, immediate resuscitation, and/or treatments. I understand that I assume all risks and associated costs. If I am unable to be reached at the contact information I have listed above, I hereby authorize the performance of such procedures as necessary, and advisable for the welfare of my pet in the professional judgment of the veterinarians on staff at Ness Exotic Wellness Center.
REQUIRED Reptile Procedures/Testing (please provide most recent dates)
INNER OFFICE USE ONLY
Exemption(s) of _________________________ services and/or testing as approved by Dr. _________________ on the date of ______________, due to ____________________________.