New Client Information

Consent Form

To: Retama Equine Hospital, Inc
Owners Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Color of Animal:*
Sex of Animal:*
Age of Animal:*
Breed of Animal:*
I am the owner or agent for the owner of the above named animal and have authority to execute this consent. I hereby consent and authorize the performance of the following procedure(s) or operation(s):*
I understand that during the performance of the foregoing procedure(s) or operation(s),
unforeseen conditions may be revealed that necessitate an extension of the foregoing
procedure or operation than those set forth above. Therefore, I hereby consent to and
authorize the performance of such procedure(s) or operations (s) as are necessary and
desirable in the exercise of the veterinarians’ professional judgment.
I also authorize the use of appropriate anesthetics, and other medications, and I understand that the hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised as to the nature of the procedures or operations and the risks involved. I realize the results cannot be guaranteed.
I have read and understand this authorization and consent.
Printed Name (for e-Signature)*

First NameLast Name
Today's Date*

MonthDayYear
Are you a robot?*
Should be Empty:

Consent Form