Sedation or Anesthesia

Full name
Additional procedures
Do not revive
Post-operative care
Acknowldegement of procedures
• I understand the animal must be picked up by close of business today unless directed otherwise by the veterinarian, and that if the animal is not picked up on the specified date, the Animal Center of Mid-America will try to contact me, but I agree that:
• If I do not pick up the animal on the specified date, and the veterinarian determines that the animal requires overnight emergency medical treatment, I authorize the Animal Center of Mid-America to transfer the animal to the Animal Emergency Clinic (or to another 24 hour emergency facility chosen by the veterinarian) for such medical treatment, and I agree that I am responsible for all costs associated with transport to such emergency facility as well as all costs for any care provided to the animal while under the emergency facility's care/supervision.
• If I do not pick up the animal on the specified date, and the animal does not require overnight emergency medical treatment, or I do not pick up the animal at the completion of any emergency medical treatment, I understand and agree that:
- The animal will be held by the Humane Society of Missouri in its shelter facilities without overnight medical supervision; and
- I release the Humane Society of Missouri of any responsibility for injury or illness that may arise from my animal being present in the shelter facilities; and
- The Humane Society of Missouri may provide care to stabilize my animal's condition and/or to relieve and reduce suffering by my animal, but shall not be responsible for providing any additional diagnosis, medical treatment, and/or surgery beyond this level of veterinary service; and
- I will be responsible for all additional costs incurred in holding and any additional treatment provided to my animal; and
- The ownership of my animal may be relinquished to the Humane Society of Missouri, and the Humane Society of Missouri may determine the disposition of the animal, including adoption or euthanasia, in the sole discretion of the Humane Society of Missouri.
Pickup agreement
By typing your name here and submitting you agree to the terms above.