I hereby authorize the veterinarian to examine, prescribe for, and treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. WE DO NOT BILL.

I hereby grant permission for the release of any or all of the information contained in the initial medical record of my pet(s), listed above, to be given upon request to another veterinary practice or other party. This release will remain in effect until otherwise notified by you in writing of desired changes.