18577 Natchez AvenuePrior Lake, Minnesota, 55372
Cleary Lake Veterinary Hospital Equine
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Please complete this form to request an appointment. Please note that you do not have an appointment until you receive confirmation from us. Thank you!
I hereby authorize the performance of those diagnostic, anesthetic, surgical and therapeutic procedures as recommended, in the best interest of my horse by the clinical staff of Cleary Lake Veterinary Hospital. I understand that all reasonable precautions will be taken to assure the safety and well-being of my horse while in the hospital. I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I realize that results cannot be guaranteed.
I understand that during the performance of the foregoing procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) or different procedure(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment.
DEPOSIT IS REQUIRED UPON ADMITTANCE; FULL PAYMENT IS DUE UPON DISCHARGE.
A $30 service charge will be assessed for a returned check. I have discussed the estimate costs for the procedure(s) with a staff member of Cleary Lake Veterinary Hospital and I fully understand I am financially responsible for all costs incurred including 1 ½ % interest or $1.00 billing charge, whichever is greater, assessed monthly on unpaid balance.