Winchester Animal Hospital

901 North Loudoun Street
Winchester, VA 22601



Treatment Consent


Please forward all previous records to



Treatment Consent Form

Owner's Name (required)
First Name (required)
Last Name (required)
Treatment Consent Form For (Pets Name): (required)

Date: (required) :

I hereby authorize the veterinarians of the Winchester Animal Hospital to perform the approved procedure(s) on my pet along with any additional diagnostic and/or treatment procedures as deemed advisable or necessary for my pet. I understand that any additional procedures may increase the final cost. I understand that the hospital requires that all pets have a recent physical examination, be free of all parasites, and be current on vaccinations. I realize that there is always risk when anesthetics and other medications are used if surgery is performed. I understand that results can not be guaranteed. The Winchester Animal Hospital has medical staffing: Monday through Friday 7am - 6pm and Saturdays 7am - 5pm. Sundays as needed. If the doctor feels it is necessary, you will be asked to take your pet to the Veterinary Emergency Center for overnight care.
Where can we reach you today? (required)

If my pet is here for an illness or injury, and the doctor feels it is necessary for the diagnosis of my pet. I am authorizing the following: (required)

Laboratory work - I am aware that it could be between $60-$200
X-rays - I am aware that radiographs could be between $200-$325
Call me before performing any services

Payment is due when pets are picked up from hospital.
Initial: (required)

I agree that I have read all of the information provided on this form and that all of the above information I have provided is true. (required)

Yes, I agree

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