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Authorization and Waiver for Pet Health Care

VSMR has disclosed to me the nature of sports medicine and Rehabilitative veterinary medicine. I authorize VSMR to use the recommended treatments on my pet/s. I understand that VSMR's recommendations and treatments of my pet constitute no guarantee of results. I further understand that VSMR's recommendations and treatment are based upon the information that I supply and that I am not a veterinarian skilled in identifying the full extent of possible symptoms. In consideration of the foregoing, I waive and release any and all rights, claims, and causes of action I have or may have against VSMR and its affiliates, officers, directors, employees, representatives, successors and assigns, that may arise as a result of any of VSMR's recommendations or treatment of my pet/s, including but not limited to any hydrotherapy, veterinary acupuncture, veterinary spinal manipulation therapy, therapeutic exercise or other treatments or care. I agree that there are inherent risks to be associated with the use of the VSMR facilities arising out of or associated with use and conditions such as wet floors, exercise mats, and other dogs. In consideration for VSMR granting me permission to use their facilities, I agree to release VSMR from liability arising out of or associated with such use and hereafter waive any and all claims which may arise out of or be associated with such permissive use of the VSMR facilities.*

I have read and agree

Veterinary Sports Medicine & Rehabilitation Policies

APPOINTMENT TIMES: Patients are allotted a 30-minute block of time for treatment, questions, and client instruction at each appointment. The treatment portion will vary based on the patients' ability and tolerance to complete the session. The treatment time is always at the discretion of the Rehabilitation Technician or Veterinarian working with the patient.*

I have read and agree

CANCELLATIONS, LATE ARRIVALS & MISSED INITIAL EVALUATIONS: Initial Evaluations require a $100 deposit. Evaluations canceled with less than 24-hour notice are subject to forfeiture of deposits. Arriving more than 10 minutes late for evaluations will require rescheduling and forfeiture of the deposit.*

I have read and agree

CANCELLATIONS, LATE ARRIVALS & MISSED APPOINTMENTS: Appointments cancelled with less than 24 hours notice, as well as missed appointments, are subject to a $50 Cancellation Fee. (Rehabilitation and Fitness package holders will forfeit the appointment). Appointments for late arrivals will be shortened to meet the scheduled completion time unless time is available to enable an extension. Appointments arriving more than 10 minutes late will need to be rescheduled and a $50 Cancellation Fee will be charged. (Rehabilitation, Maintenance and Slim Club package holders will forfeit the appointment.) Cancellation fees are payable within 30 days or before the next appointment, whichever is earlier.*

I have read and agree

UNDERWATER TREADMILL SESSIONS: Underwater Treadmill sessions are scheduled in 30-minute blocks. The treatment portion will vary based on the patients' ability and tolerance to complete the session. The max treatment time on the treadmill is 20 minutes. At the end of the session, the animal rehabilitation therapist will rinse and dry your pet. Use of the blow dryer is at the discretion of the therapist and is based on your pets' cooperation. Appointment for late arrivals will be shortened to meet the scheduled completion time unless time is available to enable the extension. Appointments arriving more than 10 minutes late will need to be rescheduled, and a $50 cancellation fee will be charged. (Rehabilitation and Maintenance package holders will forfeit the appointment).*

I have read and agree

CART FITTINGS: Our clinic works with K9 Carts, and the requirements for the carts are specific to their company. Once the cart has been ordered, it may take anywhere from 1-3 additional fittings to correctly fit the new cart to your pet. The cost of these additional fittings is not included with your initial fitting. A cart is not a replacement for rehabilitative medicine and is solely for mobility purposes.*

I have read and agree

ORTHOTICS: An initial fitting appointment is scheduled once the device is shipped to our clinic, and the cost of this appointment is in addition to the cost of the initial fiberglass impression session and the cost of the device. Due to the custom fitting of the device, subsequent appointments may be required to make adjustments to the device after the initial fitting appointment and are an additional charge.*

I have read and agree

FINANCIAL POLICY: Payment is due in the form of cash, personal check, Master Card, or Visa at the time services or products are provided. Delayed payment or returned checks are subject to a $25 fee. All services purchased and fulfilled are non-refundable. We will be able to refund the price for any unused services due to medical issues or unforeseeable circumstances. We will not refund the full or partial price for gift certificates purchased. Products purchased at VSMR may be returned for a full refund if they are unopened and returned within 30 days of purchase. Special orders cannot be returned.*

I have read and agree

HEALTH & SAFETY: Pets must be clean, well-groomed (including trimmed nails), and parasite-free with no signs of fleas, ringworm, mange or contagious diseases before coming to VSMR for treatment. VSMR reserves the right to refuse pet/s based on these criteria. All pets must be restrained by a leash or placed in a kennel or carrier prior to entering VSMR and must remain so while in our facility unless being treated by a veterinarian or animal rehabilitation therapist. This is for your pet's safety, the safety of other pets. Rehabilitation and clinic equipment is to be used only by or under the supervision of the staff in caring for our patients. Do not attempt to use, climb, jump or balance on any of the rehab and clinic equipment you may encounter during your visit. Do not enter another treatment room, hydrotherapy room, rehab therapy gym or other room in the center unless escorted by a staff member.*

I have read and agree

MEDICAL EMERGENCIES: Should an accident or medical problem occur while your pet is boarding with us for the day, half-day, or the treatment time and immediate intervention is needed, a VSMR veterinarian shall oversee necessary treatment and contact you and your primary care veterinarian as soon as possible. Should your pet need immediate treatment beyond the scope of VSMR's capabilities, such as surgery, your pet will be transferred to Colonial Manor Animal Hospital.*

I have read and agree

TALENT RELEASE: Veterinary Sports Medicine & Rehabilitation often photographs and videos patients while at VSMR for the purposes of education, promotion, or advertising. Please select one of the following:*

I authorize the use of my pet's image or likeness for these purposes
I do not authorize the use of my pet's image or likeness for these purposes

Please type your digital signature signifying you have read and understood the above Veterinary Sports Medicine & Rehabilitation waiver and policies.

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Policy Form

Authorization and Waiver for Pet Health Care

Veterinary Sports Medicine & Rehabilitation Policies

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