Drug Waiver (Blood Monitoring) Form

Please fill out this form if you plan on picking up prescribed medication/s and do not plan to have the recommended yearly blood monitoring test done for your pet/s.

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Drug Waiver (Blood Monitoring) Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 802-888-7776 for a faster response.

Updates on COVID-19 – Hospital Policies For All Appointments
*This form is required for all appointments with a doctor. Please fill this form out at your earliest convenience and at least 24 hours before your appointment.

Name *

First

Last

Date *

Pet's Name *

Prescribed Medication *

We recommend yearly blood monitoring for all pets that are on this medication. Potential complications of giving this medication without prior testing include internal organ damage and/or death. *

I understand the above statement

By signing this form you understand that your pet is being treated with a medication that has the potential for serious side effects. You understand that Sequist Animal Hospital recommends regular blood monitoring for pets that are on the medication indicated above. You are aware of the potential complications of your pet's medication and have elected not to follow the recommended blood monitoring schedule. You agree to release Sequist Animal Hospital of all claims arising from not following their recommendation concerning drug monitoring. *

I understand the above statement

Initial Here *

By typing your initials in this box you agree to all of the above and fully understand the potential complications.

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Drug Waiver (Blood Monitoring) Form

Drug Waiver (Blood Monitoring) Form

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