Patient Drop-off/ Treatment Consent Form

I verify I am the owner (or authorized agent for the owner) of the above named pet and authorize the above treatment(s) to be
performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that
hospital personnel will be employed in the procedure as directed by the veterinarian. I agree to be responsible for any charges
incurred while my pet is in the care of Bensenville Animal Hospital, a treatment care plan has been provided to me, and I understand
payment is due at the time my pet is discharged from the hospital. I understand that if my pet requires overnight round-the-clock
specialty or emergency care, I may be referred to a 24 hour emergency veterinary hospital and my pet will require owner-provided
transportation prior to the end of day at Bensenville Animal Hospital.