Bloodwork Decline Waiver

Name: Pet Kare Clinic
Address: 102 Anglers Drive, Steamboat Springs, CO, 80487
Telephone: +1-970-879-5273
Price range: $$

Your Name*
First Last
Email Address*
Pet's Name*
Medication Requested Without Bloodwork*
I understand the risks associated with the medication list above and why bloodwork is recommended while on this medication. With this knowledge, I decline to do bloodwork at this time and assume liability for any complications that may arise from this choice. I understand that the decision to bypass bloodwork at this time is contrary to the recommendations of the Pet Kare Clinic, regardless of how frequently or infrequently my pet receives this medication.

This waiver is good for 6 months from this signed date. Pet Kare Clinic highly recommends that bloodwork be done during this time period. If no bloodwork is done within 6 months of this date, we will need to have another waiver signed for more medication to be dispensed.
Acknowledgement*
- I acknowledge that my typed signature below constitutes a legally binding agreement
Signed By*
Date: 01/19/2025