1010 Montauk Hwy, Shirley, NY 11967      

ADMIT
SURGERY FORM
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AUTHORIZATION FOR MEDICAL AND / OR SURGICAL TREATMENT

I, the undersigned, owner of admitted patient, hereby authorize Shirley Veterinary Hospital, and whomever the may designate to administer such treatment as is necessary and to perform surgical procedures as deemed necessary and such 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 such anesthetics as are necessary.

I hereby certify that I have read and fully understand the above Authorization for Medical/or Surgical Treatment, its advantages, and possible complications. I also certify that no guarantee or assurance has been made has been made as to the patient and I understand payment is due in full at the time of discharge.

RELEASE OF ANIMALS

The Client agrees to remove the animal when a request for removal is made; the request may be made personally, by telephone or by letter mailed to the Client. Should the pet not be removed within the within the specified time, the Client hereby relinquishes all claims to the animal and Shirley Veterinary Hospital, and whomever they may designate is at liberty to male whatever disposition of the animal as it may seem fit.

In the event of death of the animal,Shirley Veterinary Hospital and whomever they designate will, unless otherwise instructed by the Client, arrange for the disposition of the body.

PAYMENT POLICY

The Client realizes that in many cases, it is not possible to determine in advance the exact extent of medical or surgical treatment required for the animal.

Shirley Veterinary Hospital and whomever they designate will attempt to estimate the cost of the treatment but it is understood that the final cost may exceed the estimate, depending on the extent of the treatment required.

 

LATE CHARGES

In some instances, charges for services rendered in the hospital may still be in the processing stage when you pick up your pet. The Client agrees to pay for these services at the time of discharge. these charges are subject to finance charges at the rate of 1.5% Month(18% per annum or the maximum allowable by law).

1010 Montauk Hwy, Shirley, NY 11967

1010 Montauk Hwy, Shirley, NY 11967

receptionist@shirleyvet.com

beyre@shirleyvet.com

Shirley Veterinary Hospital

Welcome to Shirley Veterinary Hospital! We are a leading veterinary practice serving pets and owners in Suffolk County, Long Island, and the surrounding areas.

WE OFFER

REHABILITATION FACILITY FOR PETS
REHABILITATION FACILITY FOR PETS
HOSPITAL AFFILIATION

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