Client Consent
Clinic Policies & Medical Consent
By bringing your pet for services at Essentials PetCare, you agree to the following terms:
Clinic Policies & Procedures Consent: Essentials PetCare, LLC
Revised 6/1/2021
The pet owner or pet owner’s agent agree to abide by the following terms and conditions of Essentials PetCare’s Clinic Policies and Procedures.
CONSENT TO EXAMINATION OR TREATMENT
I consent to the examination or treatment of my pet by staff veterinarians at this clinic. My consent covers all pets I may present for examination or treatment, and remains in continuous effect while I am a client of Essentials PetCare until revoked by either party in writing. I understand that after consultation with me or my authorized agent, the clinic’s doctors may prescribe medication for my pet. Should my pet require life-saving emergency care and the attending veterinarian is unable to reach me, I authorize this clinic’s staff to provide emergency treatment to my pet and I agree to pay for all related fees.I understand that Essentials PetCare is a retail animal clinic, offering basic preventative and basic acute illness care. As such, I understand that this clinic is not designed to diagnose or treat complex medical problems. I also understand that this clinic does not perform any surgical, emergency, or hospitalization services.
For Florida clinics: I understand that pursuant to Florida’s Veterinary Medical Practices Statute, Chapter 474, Florida Statutes, and the administrative rules promulgated thereunder, the staff at this clinic is required to collect and to record vital information from my pet, including but not limited to temperature, pulse, and respiration, during each clinic visit.
If any of my pet’s vital signs exceed an acceptable baseline parameter, the staff may recommend immediate referral to an emergency or full-service veterinary facility. This may still result in a fee for the clinic visit at the discretion of the veterinarian on duty.
While I understand that all procedures will be performed in accordance with commonly accepted standards of care, I understand that veterinary medicine is not an exact science and that clinic staff have made no guarantees to me regarding the outcome of any services provided.
SAFETY
I understand that my safety, my pet’s safety and the safety of other clients, patients and the staff at Essentials PetCare is of utmost importance. Accordingly, I understand that I will not restrain my pet during any examinations or diagnostic and therapeutic procedures and if staff is unable to safely restrain my pet (manual restraint, muzzles, etc.) due to aggressive behavior I may be asked to remove my pet from this clinic without any clinical services being performed.
I understand that except for bona fide service animals, my pet is not allowed in the Walmart store common areas. I also understand that I am prohibited from leaving my pet unattended in a vehicle in the Walmart parking lot due to risk of serious injury or death resulting from heat exposure.
When required and notified by Essentials PetCare, I understand that except as otherwise required by law, I am required to wear a mask to accompany my pet in the clinic and that failure to wear a mask at all times while in the clinic may lead to cancellation of the appointment with no refunds for any services for which I have prepaid. I understand that this mask must appropriately cover both my nose and mouth at all times. I understand that refusal to wear a mask that covers both my nose and my mouth at all times may result in the conversion of my pet’s appointment to a contact-free visit and that refusal to participate in a contact-free visit may lead to cancellation of the appointment with no refunds for any services for which I have prepaid.
CONTACT-FREE VISITS
I understand that the contact-free visit is a combination of virtual visit, in which the veterinarian will use telephone, video conferencing, pictures, videos, and other information to communicate with me about any issue affecting my pet, and an in-clinic visit for my pet only. I understand that while my pet will be in the clinic for services, I am not allowed to accompany my pet past the designated drop-off area in the clinic or be with my pet during their visit in the clinic. Participation in a contact-free visit is in lieu of an in-person visit which may not be possible or recommended due to various reasons (including but not limited to a public health emergency).
I understand that during the contact-free visit, the staff will attempt to use teleconferencing technology so that I may remotely monitor the services my pet receives as well as have the ability to ask questions of the veterinarian and/or other staff during the visit. I understand that failure of the virtual visit technology to work appropriately during the visit is not the responsibility of Essentials PetCare and will not prevent the staff from performing the services I have selected for my pet. I understand that if I do not have the technological requirements to participate in the contact-free visit remotely, I will be unable to monitor and interact with my pet or the staff during the visit. I understand that due to the limitations of the contact-free visit, I may not be able to add services during my pet’s visit. I understand that only one adult will be allowed to drop-off my pet for the contact-free visit. I understand that I must remain close to the clinic during my pet’s appointment while my pet is in the clinic. I understand that the clinic is not boarding pets or otherwise monitoring pets when they are not receiving a service. I understand that the staff will expect me to retrieve my pet from the clinic as soon as their visit is finished, and I understand that failure to retrieve my pet when the appointment is complete may result in the pet being considered abandoned and the local authorities contacted.
I understand that failure to send my pet’s health records prior to my pet’s appointment or failure to bring my pet’s health records at the time of my pet’s appointment may result in recommendations for follow-up care that are different than the recommendations that would have been made following review of any health records, and that these recommendations will not be changed after my pet’s appointment.
ESTIMATES & PAYMENTS
I acknowledge that the costs for veterinary services at Essentials PetCare are posted in several public locations including the company’s website and on printed customer materials. I understand that an estimate can also be provided to me upon request, and that I am encouraged to discuss all fees for services with a staff member before making an appointment for my pet and before services are rendered.
I understand that changes in my pet’s condition or discovery of other findings during treatment may require a change in or an extension of the original fee estimate and, if this occurs, a staff member will provide a revised fee estimate to update the total expected cost. I understand that if further care is needed, the staff reserves the right to ask that the pet return for another hybrid visit, rather than performing the suggested care at the original appointment. I understand I will not receive a refund for any services rendered if my pet is referred to a full-service facility.
I understand that without exception full payment is due prior to arrival at the clinic in which services are rendered. I agree to provide full payment by credit card, debit card, or cash (checks are not accepted). I also understand that requests for refunds on services rendered will not be granted, and any attempts for chargebacks will be contested with thorough documentation.
RESPECT FOR OTHER CLIENTS, CLINIC STAFF & POLICIES
I agree at all times to follow Essentials PetCare policies and be respectful of other clients and clinic staff. I expressly understand that behavior such as yelling, using offensive, abusive or profane language, making derogatory or harassing comments, making demands or verbal or physical threats will not be tolerated and may result in me being asked to leave the clinic premises, clinic staff notifying local authorities, and being denied any future services at Essentials PetCare.
I understand that for the safety of clients, their pets and of staff, Essentials PetCare has a 2-pet limit per family per visit. Essentials PetCare will not permit more than 2 pets in an exam room. I am aware that bringing more than 2 pets to a single visit may result in a denial of services for my pets.
When required and notified by Essentials PetCare, only one masked adult may enter the clinic for the pet’s appointment. If the masked adult presenting the pet(s) to the clinic cannot safely and adequately handle both pets, the staff may ask that you bring in your pets one at a time or convert the appointment to a contact-free visit.
PRESCRIPTIONS & MEDICATIONS
It is the pet owner’s responsibility to fill his/her pet’s prescriptions. After receiving a portable prescription, I understand that I must deliver the original prescription to a retail pharmacy or mail it to an online pharmacy. I understand that the staff at Essentials PetCare cannot complete authorizations for prescriptions submitted online or by fax to external pharmacies. I also understand that a fee will be assessed to replace a lost prescription and I understand that Essentials PetCare reserves the right to not replace a lost prescription, pursuant to patient health and/or regulatory limitations.
I understand that any issues related to medications obtained outside of the Essentials PetCare clinic must be addressed by the medication’s manufacturer and/or seller. Essentials PetCare is not liable for any medications obtained from any other source.
RABIES
Failure to provide proof of current rabies vaccination status may result in this clinic declining to provide care for your pet, until such proof is furnished. The clinic director or staff veterinarian will be the sole decision maker on whether a patient is required to have a current rabies vaccination prior to examination or treatment.
State law requires vaccination of all dogs and cats, 4 months of age and older, for rabies. In addition to helping prevent the spread of the rabies virus, confirmation of your pet’s rabies vaccination is the primary factor to determine the type of medical treatment a bite victim receives and how state health officials handle your pet if he/she has bitten a human or other domestic animal. Accordingly, it is essential that Essentials PetCare be able to document your pet’s rabies vaccination status. Acceptable rabies documentation includes a rabies certificate, or a letter, fax, or phone call from your veterinarian with the date of vaccine administration, duration of recognized immunity, serial or lot number, and expiration date of the vaccine.
If you cannot substantiate your pet’s rabies vaccination status, this clinic must consider that he or she is unvaccinated and the following public health regulations may apply:
- An unvaccinated pet that bites any person or animal, but neither dies nor is euthanized, must be strictly quarantined at owner expense for ten days at a facility approved by a public health officer.
- The head of an unvaccinated pet that bites any person and dies or is euthanized within ten days of the bite must be sent to the Georgia Public Health Laboratory for rabies testing.
- An unvaccinated pet that is exposed to a known or potentially rabid animal may be euthanized immediately or be placed in strict isolation for 4 months. The quarantined animal should be vaccinated either upon entry to isolation OR 1 month before being released. Isolation in this context refers to confinement in an enclosure that precludes direct contact with humans and other animals.
Accordingly, it is imperative to substantiate the rabies vaccination status of your pet should he/she bite a human or another animal. If you do not have documentation evidencing your pet’s vaccination status and if your pet has no history of a recent bite wound, has not recently bitten another animal or person, and shows no symptoms consistent with rabies, you must be willing to have your pet vaccinated today based on the recommendation of the staff veterinarian.
This clinic provides rabies certificates, which can be used for pet licensing and proof of vaccination. I understand that the fee for a county license/rabies tag is not included in the cost for a vaccine and must be purchased separately, if desired.
PHOTOS & MEDIA
I consent to the audio and visual recording of any video conferencing, shared photos, and shared videos (collectively: media) used in my pet’s contact-free visit and consent to Essentials PetCare’s digital storage of the media and the sharing of such media with others, for marketing, educational or other purposes. I hereby give Essentials PetCare permission to take photographs or video of myself, my pet(s), and family members who are with me for the purpose of sharing such photographs or video with others for marketing, educational or other purposes. I hereby release and discharge Essentials PetCare from any and all claims arising out of use of this media. I acknowledge that taking photographs, video or audio recordings of any Essentials PetCare clinic or staff is strictly prohibited without prior written consent of Essentials PetCare management.
ACKNOWLEDGEMENT
I certify that I am at least 18 years of age and hereby give my consent to Essentials PetCare to administer the services I have requested for my pet. I have read and/or had explained to me the information herein and acknowledge that I have had an opportunity to ask questions and that such questions were answered to my satisfaction.
On behalf of myself, my pet and my personal representatives, I hereby release and hold harmless Essentials PetCare, its, agents, directors, officers, contractors and employees, from any and all liabilities, claims, or causes of action, arising from the treatment or attempted treatment of my pet. I further agree to indemnify and hold harmless to the fullest extent permitted by law Essentials PetCare, its agents, directors, officers, contractors, and employees against and from any and all third-party claims for liability, damages or loss; claims of injury or wrongful death; or other causes of actions to the extent such damages, loss, injury or causes of action are attributable to, were caused by, or arose from my pet or its presence at an Essentials PetCare facility.
Consent for Medical Services: Essentials PetCare, LLC
VACCINE PACKAGES
I elect to have the staff of Essentials PetCare vaccinate my pet based on the vaccine package I have requested. I understand that the examination of my pet by the veterinary staff of Essentials PetCare prior to vaccination is a limited wellness exam only to determine whether my pet is healthy enough to be vaccinated. I understand that the limited wellness exam is a supplement to a thorough physical exam administered by the veterinary staff of a full-service animal hospital. As such, my pet may have an illness or physical dysfunction that will not be diagnosed by the limited wellness exam.
I understand that failure to provide proof of previous vaccination by a licensed veterinary establishment will cause my pet to be classified as unvaccinated. Proof of vaccination(s) performed by a breeder and/or owner will not be accepted. If I fail to provide proof of previous vaccination by a licensed veterinary establishment and decline vaccinations recommended by the staff of Essentials PetCare, it may result in this clinic declining to provide care for my pet, until such proof is furnished.
I understand that the staff of Essentials PetCare will make recommendations for booster vaccinations based on many factors, and that the optimal health of my pet is the basis for all recommendations. I understand that my failure to obtain booster vaccinations at the appropriate intervals as recommended may cause my pet to require further vaccinations and/or be considered unvaccinated.
I understand that some vaccines have an ideal anatomic delivery site (area of the body where vaccine is administered), and that the staff of Essentials PetCare will strive to vaccinate my pet following standard industry practices. I understand that the temperament of my pet may require the staff to deliver a vaccine in an atypical anatomic location, but consistent with the manufacturer’s recommendations.
I understand that some vaccines may be harmful to the fetuses of pregnant animals, and may cause birth defects, significant health problems, and/or abortion. I attest that my pet is not pregnant at this time. If I believe my pet may be pregnant, but I am not certain, or if my pet is in heat, I agree to inform the staff of Essentials PetCare. I understand that the attending veterinarian may decline to administer vaccines due to health concerns.
I understand that veterinary medicine is not an exact science and that no guarantees have been made regarding the outcome of these vaccines. In rare instances, some animals fail to mount a protective immunologic response to vaccination. I understand this is a risk inherent with any vaccination.
To my knowledge, my pet has not experienced a vaccination reaction in the past. Any animal can have a vaccine reaction which can occur in animals of any age, breed or sex, even if the animal has had previous uncomplicated vaccinations. I agree to let Essentials PetCare staff know before vaccination whether my pet has had a vaccination reaction in the past.
I understand that Essentials PetCare requests that all pets visiting for vaccines arrive at least 1 hour prior to clinic closing. If I choose to have my pet vaccinated close to closing and my pet subsequently experiences a severe reaction, I understand the risk and I am aware of the following:
- Essentials PetCare may be closed and not able to offer advice or assistance.
- I may need to transport my pet for treatment at an emergency hospital or other full-service hospital, at my expense.
I understand that I need to monitor my pet for the following signs of a vaccine reaction:
- Symptoms that look like a bug bite, including hives (bumpy skin) and/or swollen face. This can happen minutes to hours after the vaccine is given. If this occurs, emergency treatment is needed – please go to the nearest veterinary emergency hospital.
- The animal almost immediately becomes lethargic, vomits, and/or collapses. The animal’s gums may also become very pale and/or its heartbeat may become slow and faint. If this occurs, emergency treatment is needed IMMEDIATELY – please go to the nearest veterinary emergency hospital.
MINOR ILLNESS PACKAGES
I understand that the examination of my pet by the veterinary staff of Essentials PetCare is a limited illness exam only to assess the body system requested (e.g. skin, ears, eyes, etc.). By selecting a particular illness package, I am representing that I believe there is a focused abnormality with my pet and I am aware the exam is limited to the area of concern. I understand that the limited illness exam is a supplement to a thorough physical exam administered by the veterinary staff of a full-service animal hospital. As such, my pet may have an illness or physical dysfunction that will not be diagnosed by the limited illness exam.
I understand that veterinary medicine is not an exact science and that no guarantees have been made regarding the outcome of any recommended treatment. I understand that clinic staff will work diligently to diagnose the cause of my pet’s condition, but the underlying cause may not be identified. I also understand that clinic staff will work diligently to ensure any recommended treatment will be the appropriate choice for my pet and will not have any negative side effects on my pet’s overall health, but that no guarantees have been made regarding the efficacy and safety of any proposed diagnosis or treatment.
I understand that health issues can represent a chronic, relapsing condition. Often, recommended medications can control symptoms, but long-term control may require a visit to a specialist or full-service animal hospital. I understand that the attending veterinarian may exercise his or her discretion and refer my pet to a local full-service animal hospital if, in the attending veterinarian’s opinion, my pet’s general health is poor, or the presenting symptoms are secondary to a serious health issue. After performing the necessary diagnostics, the attending veterinarian may refer my pet without treatment, and I understand that full payment for the package and diagnostics will still be required. I understand that I can request my pet’s records be sent to the referral hospital. The attending veterinarian may also decline to provide diagnostics and treatment recommendations if he or she believes the limited service model is too restrictive to treat my pet’s condition.
I understand that the attending veterinarian may recommend laboratory testing to help accurately diagnose my pet’s condition, which will involve an additional charge. If the attending veterinarian recommends a recheck visit after my pet’s initial visit, I understand that the regular cost of the package will apply to subsequent visits if the same diagnostics are performed. I understand that failure to rapidly improve or respond to therapy may indicate that my pet has a potentially serious problem that requires immediate attention by an emergency hospital, specialty hospital, and/or full-service animal hospital.
Important Information Regarding Specific Illness Packages:
- Skin Package: I understand that pets may harbor parasites and/or bacteria contagious to humans. The staff of Essentials PetCare will attempt to diagnose any skin condition which may be contagious, but no guarantees have been made regarding the ability to definitively diagnose a specific contagion.
- Ear Package: I understand that cleaning my pet’s ears is not included in this package.
- Eye Package: I understand that several different medical conditions can cause eye problems and cases may require repeated exams, response to therapy assessment, specialty diagnostics, and/or referral to a specialist or full-service animal hospital to determine the underlying cause.
- Urinary Package: I understand that several different medical conditions can cause urinary problems and cases may require repeated exams, response to therapy assessment, specialty diagnostics, and/or referral to a specialist or full-service animal hospital to determine the underlying cause. I understand that if my pet attempts to urinate but is unable to pass any urine, that this symptom represents an emergency and my pet must be seen by an emergency or full-service animal hospital immediately.
- GI Upset Package: For canine patientsthat test positive for canine parvovirus, I understand this will result in an immediate referral for additional testing and potential treatment at a full-service hospital. Full payment for the package will be due to cover extensive clinic disinfecting protocols that must be implemented.
- Lameness Package: I understand that prior to prescribing treatment to control the symptoms of musculoskeletal discomfort, blood and urine testing may be necessary to determine whether my pet’s internal organs are healthy enough to process the medications. I further understand that during the course of treatment additional tests may be necessary to determine whether any prescribed medication is negatively affecting my pet’s internal organs. This testing may be limited and unable to diagnose any specific health condition. I understand that if I decline the recommended testing, the attending veterinarian reserves the right not to write a prescription or approve refills for any medication, without current results from any recommended tests. I understand that different musculoskeletal problems may have similar symptoms. Without specialty diagnostics such as x-rays, clinic staff may not be able to completely ensure that my pet does not have a very serious issue including but not limited to fractures, cancers, infection, and ligament/tendon injuries.
ACKNOWLEDGEMENT
I certify that I am at least 18 years of age and hereby give my consent to Essentials PetCare to administer the services I have requested for my pet. I have read and/or had explained to me the information herein and acknowledge that I have had an opportunity to ask questions and that such questions were answered to my satisfaction.
On behalf of myself, my pet and my personal representatives, I hereby release and hold harmless Essentials PetCare, its, agents, directors, officers, contractors and employees, from any and all liabilities, claims, or causes of action, arising from the treatment or attempted treatment of my pet. I further agree to indemnify and hold harmless to the fullest extent permitted by law Essentials PetCare, its agents, directors, officers, contractors, and employees against and from any and all third party claims for liability, damages or loss; claims of injury or wrongful death; or other causes of actions to the extent such damages, loss, injury or causes of action are attributable to, were caused by, or arose from my pet or its presence at an Essentials PetCare facility.
