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Proudly Serving the Pets of
Wayne, NJ
1302 Hamburg Turnpike, Wayne, NJ
(973) 831-2426
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About
Meet Our Staff
Howard Silberman, VMD
Christina Torres, DVM
Board-Certified Consultants
Staff
Take a Tour
Cat Friendly Practice
Testimonials
Services
Canine Wellness Health Care
Puppy Wellness Care
Adult Dog Care
Senior Dog Care
Feline Wellness Health Care
Kitten Wellness Care
Adult Cat Care
Senior Cat Care
Surgery
General Surgery
Orthopedic Surgery
Advanced Surgical Care
Advance Diagnostic Care
Anesthesia
Behavior Counseling
Cardiology
Cold Therapy Laser
Dental Care
Dermatology
Drop-Off Appointments
Microchip Implantation
Nutrition / Supplements
Pain Management
Pharmacy
Radiology
Testimonials
Forms
Client Welcome Form
Prescription Refill
Upload Records
Contact
Hospital Policies
Request an Appointment
Emergency
Hospital Policies
Home
About
Meet Our Staff
Howard Silberman, VMD
Christina Torres, DVM
Board-Certified Consultants
Staff
Take a Tour
Cat Friendly Practice
Testimonials
Services
Canine Wellness Health Care
Puppy Wellness Care
Adult Dog Care
Senior Dog Care
Feline Wellness Health Care
Kitten Wellness Care
Adult Cat Care
Senior Cat Care
Surgery
General Surgery
Orthopedic Surgery
Advanced Surgical Care
Advance Diagnostic Care
Anesthesia
Behavior Counseling
Cardiology
Cold Therapy Laser
Dental Care
Dermatology
Drop-Off Appointments
Microchip Implantation
Nutrition / Supplements
Pain Management
Pharmacy
Radiology
Testimonials
Forms
Client Welcome Form
Prescription Refill
Upload Records
Contact
Hospital Policies
Request an Appointment
Emergency
Hospital Policies
Fill Out the Client Consent Form
"
*
" indicates required fields
Name
*
First
Last
Pet's Name
*
Email
*
Number(s) Where I Can Be Reached Today:
*
Procedures to be performed today:
General Information Regarding Visit:
*
Medications and Food Given Today:
*
Please make a selection:
*
I prefer that you proceed with all necessary procedures.
I prefer to be called before any additional procedures, other than emergencies, are performed.
If I cannot be reached by phone, I do not authorize any unforeseen procedures.
Consent Required:
*
I am the owner, or authorized agent for the owner, of the animal specified above. I am over 18 years of age and have the authority to execute this consent. I understand that there are risks with any anesthesia and surgery. My signature on this form indicates that I understand the procedure that will be performed and the possible complications. The procedure has been explained to me and I further understand that during the course of the procedure, unforeseen conditions may arise that may necessitate the performance of additional procedures.
Consent Required:
*
I assume financial responsibility for the fees and will pay by cash, credit card, or check at the time my pet is discharged. If I cannot pay in full at the time of service, I must notify Tri-County Animal Hospital prior to treatment. A monthly service charge of 2% will be applied to any unpaid balance. As the person responsible for this pet, I will be responsible for all attorney and collection costs should steps be necessary.
Signature
Date
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Email
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