Consent To Treat Form

Save time during your visit. Complete your required forms online from any device at any time before your visit.

Consent To Treat 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.

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone Number *

By checking this box, you consent to receive promotional, transactional, and/or informational text messages from Gadsden Veterinary Associates Emergency Care at the number provided, including messages sent by autodialer. Consent is not a condition of purchase. Message & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy | Terms & Conditions.

I consent

I consent

Email *

Pet's Name *

Species *

Breed *

Color: *

Age: *

Immediate life-saving or stabilization care that may total up to $500. For further care, a treatment plan will be created which will include pricing for further care so that you can best decide the plan for your pet.

Signature *

Clear Signature

Date *

Consent To Treat Form

Consent To Treat Form

Emergency and Urgent Visits — Walk-Ins Only

Location

Contact Details

Hours

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