Liability Discalimer Form | 3H Mobile Equine Vet

Disclaimer

Owner's Name

Address

Street Address City State ZIP Code

Email

I am the owner or the agent for the owner of the animal(s) described above, and I have the authority to execute this consent.

I hereby consent and authorize Dr. Fernando Cardenas, Dr. Elaine Means, Dr. Tracy Tinsley, Dr. Erin Slaighter, Dr. Ashleigh Crowell or Dr. Candince Lorandeau to perform the following procedures or operations:

The nature of these operations or procedures has been explained to me, and I understand what will be done.

I have also been informed that there are certain risks and complications associated with any operation or procedure of this type. They have been explained to me as well. I further understand that during the course of the operation or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures.

I authorize the use of appropriate anesthesia and pain relief medications as needed before or after the procedure. I have been informed that there are risks associated with the use of any medications.

Electronic Signature of Client*

Date*

MM

DD

YYYY

Name

This field is for validation purposes and should be left unchanged.