Hold Harmless Waiver of Treatment Agreement

Hold Harmless Waiver

Please complete the following information. All entries are required. You will be redirected to an electronic signature gathering site upon completion of this form.

  • MM slash DD slash YYYY
  • Please select your pet's species.
  • Please enter your pet's age.
  • Please enter your pet's age. You may approximate if birth date is unknown.
  • Please describe the service or medication that has been recommended to you by your attending DVM for which you are requesting a waiver.