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  • Your Pet's Information

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  • Your 2nd Pet's Information

  • As the owner or authorized agent of the above-named pet(s), I hereby consent and authorize the hospital to receive, prescribe, treat, or operate on this pet(s). I give Livewell Animal Hospital {location} permission to give my pet's medical history to other veterinary professionals when necessary. I understand that all fees are due and payable upon the release of the patient. If the patient has to be admitted for treatment, a deposit may be required at that time.

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