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Hospital Procedure, Drop-Off Examinations & Medical Authorization Release Form

Drop-Off Examinations

The technician admitting your pet this morning will be unable to assess its condition or provide an accurate treatment plan of fees without prior examination by a doctor. The doctor will examine your pet as soon as possible and you will be contacted by phone, to discuss your pet’s condition, the doctor’s recommendations, and a fee or treatment plan. Until we reach you by phone, no diagnostic work or treatment will be performed except emergency first aid as needed. Beyond examination and emergency first aid treatment, no charges will be incurred before the doctor contacts you. Please leave a telephone number where you will readily be available.


Drop-Off Procedures/Hospitalization

Once an estimate for procedures and hospitalization are signed and/or approved, we will begin obtaining diagnostics and treating your pet as discussed with doctor. As procedures are completed, treatment plans are modified, or if your pet’s condition changes, the Bird and Pet Clinic of Roseville will update you by phone.



You are required to leave a deposit (50% of the treatment plan) before your pet can be dropped off. The deposit will be applied towards the examination, hospitalization, procedures, and treatments. You are responsible for full payment for all services rendered, due at the time discharged.

If you are unavailable for phone consultation or fail to provide an appropriate deposit, the Bird and Pet Clinic of Roseville is not responsible for providing treatment beyond emergency first aid. You must pay for any emergency treatment that the Doctors of Bird and Pet Clinic feels is required to keep your pet alive in case of emergency. The cost varies depending on treatment.

If your pet’s condition is serious enough to warrant a recommendation of humane euthanasia, we will require your authorization prior to procedure.

If your pet is found to have fleas, we will administer a dose of Capstar (Capstar is a temporary flea control tablet that should not replace a monthly flea treatment) to prevent flea infestation within the clinic. This is for the health and wellbeing of all animals in the hospital. The cost of the Capstar treatment will be added to your final charges.

  • Date Format: MM slash DD slash YYYY
  • Current Diet:

  • Medication

  • How many tablets, capsules, or ccs were administered?