Surgical Authorization Form

I authorize and direct the veterinarian and staff of Animal Kingdom Veterinary Hospital to perform such diagnostic, surgical, and treatment procedures deemed advisable or necessary for my pet.

The nature of the procedure(s) has been explained to me and no guarantee has been made as to the results or cure. I fully understand that there may be risk to such procedures and further release Animal Kingdom Veterinary Hospital, or its agents of any liability in any manner regarding the care, treatment or safekeeping of the animal described above.

I agree to pay, in full, for services rendered, including those deemed advisable or necessary for medical and/or surgical complications or otherwise unforeseen circumstances. Any estimate of charges or fees for presently planned procedures is only a best approximation, and the full bill may be less or greater than this amount. Should there be an
outstanding balance for charges, I agree to pay, in addition to any sum due, a handling fee of $5.00 and/or 2% of the total per billing cycle. Should it become necessary for my account to be placed with a professional and/or attorney for
collection, I agree to be further responsible for reasonable attorney's fees as well as all incurred court costs.

In order to protect your pet, it is the policy of Animal Kingdom Veterinary Hospital that all pets in for hospitalization, boarding, grooming or any non-emergency procedure be current on vaccinations and flea control. If verification of vaccinations cannot be provided, Animal Kingdom Veterinary Hospital will administer the necessary vaccinations and flea control at the owners expense.