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Our Hospital
Our Doctors
Forms
Hospital Tour
Careers
Services
Wellness Exams
Dental Care
Vaccinations
Microchipping
Spay & Neuter
Senior Wellness
Surgery
In-House Laboratory
Happy Visit Mondays
View All Services
New Clients
Payment Options
News
Donate to Paisley Paws
Download Our App
Clinic Policies
COVID-19
Does Your Pet Have Heart Disease?
Shop Online
Contact Us
Make An Appointment
920-725-8307
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Against Medical Advice Form
Against Medical Advice Form
Patient's Full Name
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Client's Full Name
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Client's Phone Number
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Client's Email Address
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Prescribing/diagnosing Veterinarian's name
(Required)
The Veterinarian noted above has recommended bloodwork, method of treatment, or means of diagnosing a medical condition. The Veterinarian believes the recommendations stated are in the animal’s best interest.
The recommendation(s) being made for the patient noted above include the following
(Required)
At this time, I decline to follow the recommendations noted above. I understand the risks involved in proceeding without following the recommendations by my veterinarian and veterinary medical staff. I release Appanasha Pet Clinic and all of it's staff from any and all liability or medical claims which may result from my refusal to follow these recommendations.
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I decline the recommendations noted above.
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