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Montgomery Animal Hospital
827 Bethlehem Pike
Flourtown, PA 19031
(215) 233-3958
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I certify that I own the animal named above. I consent and authorize Montgomery Animal Hospital and its staff to hospitalize my pet and to administer whatever sedation, tests, surgical procedures, treatments, medications and vaccinations that the doctors deem necessary for the health, safety and well-being of my pet while it is under their supervision. I understand that some pets may be required to stay overnight following the surgery either because of the nature of their surgical procedure or because of their failure to adequately recover from the anesthesia, and that there may be a fee for such overnight stays.

If my pet should injure itself in an escape attempt, refuse to eat, soil itself, become ill or die while in the hospital, I agree not to hold Montgomery Animal Hospital and/or its staff responsible and/or liable in the absence of gross negligence. I agree not to hold Montgomery Animal Hospital and its staff responsible for complications caused by my pet's postoperative overactivity, scratching, chewing or rubbing at his/her's surgical site. If repairs for such activities are required, I agree to pay for all costs needed to repair any self inflicted postoperative damage.

I further agree that I am responsible to pay in full for the listed procedures/treatments at the time my pet is discharged. If I fail to pick up my pet within five (5) days of receiving written notice mailed to my address on record, Montgomery Animal Hospital may consider my pet to have been "abandoned" by me. The hospital then has my permission to dispose of my pet as it sees fit. I understand that "abandonment" does not release me from my obligation to pay my pet's bill including any extra costs incurred due to my "abandonment."

I further agree that in the case of nonpayment of my pet's bill, a finance charge of 1-1/2% per month (18% per annum) will be charged on the unpaid balance, and that the finance charge and any collection fees incurred by Montgomery Animal Hospital will be paid by me.
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