I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above described pet and provide any pertinent medical records to other Veterinarians or medical professional involved in my pet’s care unless requested otherwise. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid when services are rendered and that a deposit may be required for treatment.

Pacific Northwest Pet ER & Specialty Center requests permission to use information for internal and external use such as: research, education and social media. I authorize the use of my pet’s first name, photograph and clinical information (including at times medical condition, treatment and prognosis). Under no circumstances will my name, my personal or financial information be shard through these sources.