Consent Form

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Full Name

Phone Number

Full Home Address

Email Address

Pet's Name

Payment is due at time of service. We accept cash, check, and all major credit cards.

We will arrive at your home within a time window of 30 minutes before/after your scheduled appointment time. We will send you a text message with our ETA when we are on our way to your home.

We are unable to provide emergency services, surgical/sedation procedures, or radiographs at this time. If your pet is experiencing an emergency, please contact the Pet Emergency Center at (360) 848 - 5911.

Depending on your pet's temperament during your appointment, we may prescribe sedation medication and reschedule your exam for a later date.

We use VetSource online pharmacy for medication requests and refills. Once ordered through our practice, your pet's medications will arrive at your home within a few business days.

We require a current yearly exam on file to authorize medication refills (your pet must have been seen within the last year). New prescriptions require an updated exam so that Dr. Bell may examine your pet prior to prescribing any medication.

Prices for services and medications are subject to change.

May we take photos of your pet for use on our social media pages, website, and/or other promotional materials?

Yes

I am the owner or authorized agent of the animal named above and I consent to treatment administered by Bell Mobile Veterinary Care.

Owner/Authorized Agent Signature

Date

Thank you for your submission!

Text: (360) 492 - 4484

Email: BellMobileVetCare@gmail.com

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