Name
*
First Name
Last Name
Email
*
Pet's name
*
I, the owner or authorized agent for the owner of the above pet have been informed that standard veterinary procedures require that dogs and cats receiving long term medications should be tested at least annually for proper organ function, as chronic use of some drugs can lead to organ failure and other adverse reactions.
*
I consent to the recommended laboratory testing for long term prescription drug use
I decline this recommended laboratory testing. I agree to hold the veterinarians and staff at this veterinary practice harmless in the event I purchase long term medication(s) and administer it to my pet without the recommended laboratory testing and my pet subsequently develops organ failure or suffers an adverse reaction to the medication.
Signature
*
Submit
Should be Empty: