Solicitud de Servicio De Emergencia en la Clínica Veterinaria Hacienda Urbana

Emergency Service Request at the Hacienda Urbana Veterinary Clinic.

Owner name *

ID *

Identity Document

Email *

Address

Phone *

Mobile *

Pet's Name *

Breed *

I formally request the veterinary emergency service at the Hacienda Urbana veterinary clinic. *

I agree with the boarding policy

It will carry a charge of $ 2,000.00 pesos during daytime emergency and $ 3,500.00 pesos overnight emergency.

I understand that this charge exclusively implies the veterinary doctor's travel to the hospital during non-working hours, and that any veterinary service (consultation, surgery, X-rays, medicines, etc.) I will be billed additionally.

Please, choose one of the following statements, so we can take care the best we can of your pet:

I don’t give my authorization at all without my previous consent to do any additional procedure to my pet. Please, contact me before taking any action or making any decision regarding my pet.
I give my consent just when the cost is going to be no more than $_______. If the costs are more than that, please contact me first.
I authorize the appropriate treatment for my pet regardless of the cost of it, please perform all the procedures that you consider necessary, regardless of the cost.
I authorize the appropriate treatment for my pet in case of any problem that may arise in my absence, during my pet's stay at your facilities.

If you authorize the appropriate treatment, the cost of the treatment must not be more than $ _____________.

Only fill in if you choose this option in the previous question.

The payments of this services have to be totally paid by the time the client is going to do the check-out of the pet in our clinic. No exception *

I agree

Signature

ID *

Identity Document

Date *