I, the undersigned owner or agent, hereby consent and authorize Dr. Amy L. Pike (and whomever she may designate as her associate or referral) to evaluate, examine, diagnose, develop a treatment plan, prescribe for, and such additional procedures as are considered therapeutically and/or diagnostically necessary on the basis of findings during the course of said evaluation. I also consent to the administration of anesthetics, psychotropic medication or sedatives as needed.
I acknowledge that examination and/or treatment is to take place in my home, or referral facility as agreed upon, and assume all risks arising in connection therewith, including damage or injury resulting from any actions or reactions of my animal. I further understand that reactions of my animal to certain drugs or treatment may be unknown in advance and assume all risks in connection with the use of the same. The doctor(s) are to use all reasonable care and precautions, but it is understood that I assume all risks except negligence on their part. I further assume financial responsibility incurred to the patient(s) at the time of services rendered.
I further understand that no treatment will proceed without prior verbal or written consent obtained from me after discussion with Dr. Pike or her associates regarding the planned treatment or prescription and at any time I may refuse either all or part of the recommended treatment, training, medication or products.
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