Treatment Consent & Liability Acknowledgement

Guardian Name *

First Name

Last Name

Pet Name *

First Name

Last Name

Address of Treatment *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Consent & Liability Acknowledgement

I certify that I am the lawful owner or authorized guardian of the above‑named pet(s) and give permission for Apawthecary and Dr. Taylor Campione to provide veterinary care in my home. I understand: There are risks associated with in‑home veterinary care, including unexpected complications. I agree to fully disclose any known health issues, medications, allergies, or behavioral concerns. I am responsible for following all treatment and post‑care instructions. I release Apawthecary and Dr. Taylor Campione from any liability for outcomes resulting from the in‑home care performed today, except in cases of gross negligence or willful misconduct.

I have read and agree to the Consent and Liability Agreement above

Date

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