Caring for life...caring for a lifetime.
ABOUT US
WHY WE ARE HERE
OUR MEDICAL TEAM
24hr EMERGENCY & ICU
SPECIALTY SERVICES
GENERAL PRACTICE
TECHNOLOGY
Hospital tour
Resources
NEWS & EVENTS
SUCCESS STORIES
HOURS & DIRECTIONS
PLACE ORDERS
FORMS
CONTACT US
Internal Medicine
Surgery
Emergency
Critical Care
Dermatology
Avian & Exotic
Acupuncture & Chiropractic
Patient Comfort & Safety
Laboratory
DIGITAL RADIOLOGY
COMPUTED AXIAL TOMOGRAPHY (CT)
MAGNETIC RESONANCE IMAGING (MRI)
Ultrasound
Fluoroscopy
Endoscopy, Arthroscopy, Laparoscopy, Thoracoscopy
Monitoring
Ventilation
Kidney Dialysis
Prescriptions
FOOD
Authorization for Medical Care during Owner's Absence
1. I hereby give permission for (name of responsible party)
) to bring
my animals to Four Seasons Animal Hospital for treatment and/or surgery that may become necessary
during my absence from: (dates)
to
.
2. This authorization applies to the following animals:
3. In the event of a terminal illness or at the discretion and concurrence of both the doctor and the
responsible party named above, I also give permission for euthanasia.
4. I agree to be responsible for all charges and authorize the following expense:
As needed for my pet's wellness and well-being
Up to a limit of $
5. Payment will be made as follows:
I have left a check with the above designated responsible party for payment of all charges.
I will call your office and provide a credit card.
6. Special instructions or requests:
Signature
Date
Address
City
State
Phone #1
Phone #2
Email
3210 OLD TUNNEL ROAD
•
LAFAYETTE
•
CALIFORNIA
•
94549
•
(925) 938 - 7700