Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Broad Street Veterinary Hospital to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Broad Street Veterinary Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Broad Street Veterinary Hospital.