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3450 Montgomery Road, unit 14, Aurora, IL 60504
Phone no: (1 234 567 8901) Email :email@example.com
I hereby authorize Veterinarian and Staff of Sunshine
Pet hospital to handle, examine, prescribe for, or treatment of the above described pet. I undertake
the responsibility for all charges/payments incurred for my pet’s health care.
I also understand that these charges will be paid at
the time of release and that a deposit may be required for surgical treatment.