Patient Drop Off Form | Midlothian Veterinary Clinic

I understand that to effectively diagnose and treat many problems, x-rays, blood test and other procedures may need to be performed. Further, I also understand that in the event of a life-threatening condition, Midlothian Veterinary Clinic staff will make every attempt to stabilize my pet and then attempt to notify me as soon as possible

I hereby also authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you deem to be indicated.

I agree to indemnify and hold Midlothian Veterinary Clinic harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.

I hereby certify that I am the owner of the above named animal or responsible for it and have the authority to execute this consent. I further certify that I will take full financial responsibility for the treatment of this pet. I understand that payment is due in full on the day of treatment unless other arrangements have been made with Midlothian Veterinary Clinic in advance.

Monday	8:00 am	6:00 pm
Tuesday	8:00 am	6:00 pm
Wednesday	8:00 am	6:00 pm
Thursday	7:00 am	7:00 pm
Friday	8:00 am	4:00 pm
Saturday	Closed
Sunday	Closed