Authorization for Professional ServicesDate Date Format: MM slash DD slash YYYY Owner’s NamePet’s NameTimePhone NumberSecondary ContactEmail 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 readyPlease list any personal items being left with your pet toady:SignatureDate Date Format: MM slash DD slash YYYY