Verification of the Cost Structure
I understand that because of unforeseen circumstances, the cost of rendered services may exceed the above
estimate. In this case, all charges are held as low as possible. The doctors and staff of Animal Eye Care will
be glad to go over itemization and explain any charges.
I understand that it may be necessary, during the procedure or hospitalization, to provide emergency
medical care in the event that I cannot be contacted. Therefore, I consent to and authorize the performance
of such medical or surgical interventions as are necessary and desirable in the exercise of the veterinarian’s
I also authorize the use of appropriate anesthetics, and other medications, and I understand that hospital
support personnel will be employed as deemed necessary by the veterinarian.