Veterinary Food Liability Waiver
Please complete this form to acknowledge and accept responsibility regarding the food provided for your pet by our veterinary clinic.
Owner's Full Name
*
First Name
Last Name
Owner's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Owner's Email Address
*
example@example.com
Pet's Name
*
Pet Species
*
Please Select
Dog
Cat
Rabbit
Bird
Other
Pet Breed
Pet Age
*
Does your pet have any known food allergies?
*
No known allergies
Yes, please specify below
List any allergies or dietary restrictions for your pet
Type of Food Provided
*
Please Select
Prescription Diet
Over-the-Counter Pet Food
Home-cooked/Custom Diet
Treats/Supplements
Other
Please provide any additional instructions or notes regarding your pet’s food
Signature (please sign to confirm your acceptance of the waiver)
*
Submit Waiver
Submit Waiver
Should be Empty: