Save time during your upcoming appointment! Before your appointment, fill out the necessary documents online at any time from any device.
Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.
I understand that while every care will be taken. There is always some degree of risk involved with
any medical or surgical procedure, and that I have discussed any concerns I may have with the
veterinarian and hereby release, discharge and indemnify the veterinarian and any person or
corporation associated with the hospital from all actions, suits, demands, claims, causes of action
and costs of every description what so ever a law, equity and under the statute which i being the
owner of this pet or person authorised by the owner, or any other person or corporation hasn, may
have had or but for this consent could, would or might at any time hereafter have against the
veterinarian or any person or corporation associated with the hospital in respect of or arising
directly or indirectly out of the medication or surgical procedure.
I am also aware that full payment is required at the time my pet is discharged from hospital. In the
case of extended hospitalisation/ treatment, further costs may be incurred, and it may become
necessary for me to make further payments before my pets discharge date. The veterinarian on
duty will inform me if this becomes necessary.
I the undersigned, being over the age of eighteen (18) and the owner of the above pet or a duty
authorised agent, have read the above information and the terms and conditions (below), and do hereby
give my consent for the above mentioned medical/surgical treatment, and any other procedure that
should become necessary at Great Western Animal Hospital.
I certify that the above information is true and correct. I have read and understood the terms and
conditions of trade (above) of Great Western Animal Hospital Pty Ltd which form part of, and are intended
to be read in conjunction with this procedure admission form and agreed to be bound by those conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I
agree that if I am a director/shareholder (owning at least 15% of the shares) of the Client I shall be
personally liable for the performance of the Client's obligations under this contract.