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Information

Date
I consent to being 18 years or older and the legal guardian of this pet.*

Controlled Substances Agreement

I agree that any Controlled Substances prescribed will be used only for the pet they are prescribed to. I understand it is illegal to use these medications for another pet and illegal to sell or give away these medications. I will keep medications out of reach of children and other pets.*
I understand that BluePearl Pet Hospice cannot legally take back any unused controlled substances and I agree to dispose of unused medications through a local agency or Drug Take-Back Event.*
I would like to have estimates given for any additional medications for my pet.*

Photo Consent

I consent to BluePearl Pet Hospice sharing photos or videos of my pet in social media or educational materials.*

Complementary Therapy Consent:

I understand that the following are considered complementary or alternative forms of therapy: acupuncture, electroacupuncture, cool laser therapy, herbal therapy, and massage. I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained.*
By signing my full name below, I am agreeing that my electronic signature is the legal equivalent of my manual signature.*