Intake Form with Flu

I consent and authorize the pet to be examined and diagnosed by the veterinarian, who will then call me at my phone number

listed above in order to discuss recommended treatment. If my pet has fleas, ticks, or mites I understand that I will be charged

with the cost of removing them. All information given above is to the best of my knowledge and I understand I will be

responsible for the cost of services to be paid today upon discharge of my pet.