Urgent Care
Consent Form

Please fill out this form as completely as possible so we can get to know you and your pet(s). Thank you!

Pet Details

Pet Name(Required)
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Owner Details

May we text you if we cannot reach you by phone? *(Required)
After the veterinarian has examined your pet you will receive a phone call with a treatment plan and recommendation that includes an estimate of cost. In the event that we are unable to contact you, Please list your preference:



Any known reactions or allergies to medications or vaccinations?(Required)
Has your pet shown recent signs of illness such as vomiting, diarrhea, coughing or sneezing?(Required)
Has your pet shown changes in appetite, drinking or exercise habits?(Required)


Select One(Required)
The information provided on this form is true to the best of my knowledge. I authorize North Seattle Veterinary Clinic to examine and initiate for my pet. This may include treatment for shock and pain. I understand that no guarantee or warranty for success can be given and that some risks are involved in all procedures and treatments. I assume financial responsibility for charges incurred to this patient. if I am not the owner of the animal, I represent that I have been given authority by the owner to obtain medical treatment for this patient, and to incur costs of its care. I understand payment in full is due at the time that I pickup up the patient.
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This field is for validation purposes and should be left unchanged.