Authorization for Professional ServicesDate MM slash DD slash YYYY Owner’s Name Pet’s Name Time Phone NumberSecondary Contact Email Reason for today’s visit: (Please note and information you would like the doctor to know) After the examination, please call me first, before performing further diagnostic tests and treatment on the above described patient. After the examination, I consent and authorize you, Norris Animal Hospital, to prescribe, treat, and perform diagnostic procedures on the above described patient. Requested discharge time: or Call when ready Please list any personal items being left with your pet toady:SignatureDate MM slash DD slash YYYY