Patient Treatment Authorization

Please fill out our Patient Treatment Authorization Form using one of the options below if your pet is a new patient at AnimERge in Somerset County.

OPTION 1
Complete Online

Complete and submit the online form below to our email.

OPTION 2
Print & Complete

Bring the completed form with you to our hospital.

Download Form

OPTION 3
Complete on Arrival

If you prefer, complete the form when you get to our hospital.

Patient Treatment Authorization Form

Please provide us with the following information. 

Owner Information

Patient Information

Referral Information

Payment & Financing

I understand that the invoice resulting from my pet’s admission to AnimERge is to be paid in full at the time my pet is discharged.
By submitting this form, I hereby authorize AnimERge to perform such diagnostic, therapeutic and surgical procedures as are, in their opinion, necessary and advisable for treatment and maintenance of my pet’s health. While I expect all procedures to be done to the best of the abilities of the professional team, I realize that no guarantee or warranty can ethically or professionally be made regarding the results. I also authorize the veterinarian(s) and healthcare team to provide veterinary service as required or, in emergency circumstances, to follow through with such procedures as are necessary for the well-being of my pet on a continuing basis.

I am the owner or agent of the aforementioned pet, am at least 18 years of age, and am competent to contract in my own name. I have read this document in its entirety before signing below and I fully understand all of the content in this document and its meaning. I fully understand the impact of signing this release.

Caring for Pets in Somerset County

At AnimERge, our 24/7 emergency service and specialty services accepts all clients. 

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