• Owner Information

  • MM slash DD slash YYYY
  • Pet Information

  • MM slash DD slash YYYY
  • Payment Consent

  • Beacon Veterinary Specialists requires payment in full at time of service. A deposit equal to the average of the presented estimate is required prior to treatment on all patients. Any balance is due in full upon the release of your pet. I/We fully understand the payment policy of Beacon Veterinary Specialists and agree to take full financial responsibility for services rendered.
  • Authorization for Medical Treatment:

  • I, the undersigned, owner of the admitted patient hereby authorize the veterinarians and nursing staff to examine and perform such treatment and/or diagnostics as deemed necessary on the basis of findings during the course of said examination. I understand that I will be presented with a written and/or verbal estimate regarding the desired course of treatment as deemed necessary by the attending veterinarian. I also certify that no guarantee or assurance has been made as to the results that may be obtained. I hereby certify that I have read and fully understand the policies as stated above. If I do not fully understand the policies as out-lined here or have further questions regarding the treatment(s) recommended for my pet, I will request further explanation from the attending veterinarian and/or nursing staff.
  • Authorization for Emergency Treatment of Critical or Unstable Patients

  • I hereby authorize the staff or Beacon Veterinary Specialists to perform immediate diagnostics, treatments, and heroic and/or lifesaving procedures for my pet. I understand that the veterinarian will speak with me as soon as possible to inform me of my pet’s condition after assessing and initiating treatment for my pet. I authorize an initial estimate for the emergent care of my pet of $450 - $750. I understand that once my pet is stable additional treatment will likely be necessary and I will be provided with an estimate for the predicted medical plan in addition to the above costs. By my signature, I consent to this estimate and agree to pay these charges.