314-951-1534

Consent For Treatment

I, the undersigned, am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. I agree to assume full responsibility for all charges incurred as a result of examinations, diagnostic tests, medications, treatments, surgical procedures or other veterinary services provided through the Animal Medical Center of Mid-America. My signature below certifies that I am over eighteen years of age.

I understand that all reasonable precautions will be taken against injury or escape of the animal, but the Animal Medical Center of Mid-America or its agents will not be liable or responsible to any person under any circumstances for or on account of the care, necessary surgical procedures/treatment or safe keeping of the animal, and I assume all risk with respect to the treatment and care of the animal.

I understand the Animal Medical Center of Mid-America encourages all owners to have their pets microchipped for identification purposes, and that it is the Humane Society of Missouri's policy to scan pets for the presence of a microchip at the time they present for veterinary services.  If it is determined that an animal is not owned by or registered to another individual, I authorize the Humane Society of Missouri to contact this person as soon as possible to provide them with information it has concerning the animal.

I authorize the Animal Medical Center of Mid-America to release information regarding my pet's vaccination history upon request from pet grooming and boarding establishments as well from law enforcement agencies.   My questions have been answered, and I have read and fully understand this form and authorize treatment for my pet(s).

Animal Medical Center of Mid-America maintains an online and public relations presence for purposes including marketing and client education (i.e. website, Facebook page, etc.) Part of this presence includes posting and sharing photographs of our practice and its daily workings. We may be interested in using images of your pet(s) and/or family as part of the effort to educate the public about our hospital and services. We would refer to pets and people pictured by first name only, if at all.

By typing your name here and submitting you agree to the terms above.