Request for Assistance

Please upload any proof and/or certificates of previous vaccinations your pet may have.

This information is used in order to confirm the selected vaccinations and/or to determine if your pet qualifies for three year vaccination coverage at the same price.

By clicking "Submit", I acknowledge that I am the owner or agent for the animal(s) described above. I have the full and exclusive authority to execute this consent and am over 18 years of age.

• I give permission to doctors, staff, authorized agents, or representatives of this clinic to provide service(s) and treatment(s) as selected above.
• I am aware of the risks and complications associated with such service(s) and/or treatment(s) that may be given or dispensed for my pet(s).
• I further understand that unforeseen conditions may arise that may necessitate additional procedures at an additional cost.
• If life-saving emergency care is required, I authorize this clinic's doctors, staff, authorized agents, or representatives to provide treatment which they deem necessary until I can be reached.
• While the clinic strives to provide the best in veterinary services; unfortunately, no guarantee can be made regarding the outcome of the services provided. I release the clinic from any and all liabilities.