New Clients

I the undersigned, do hereby certify that I am the owner of the above animal or duly authorized
agent for the above animal. I hereby authorize Southwood Valley Animal Hospital, their agent or
representative to perform medical or surgical procedures, anesthesia, radiographic procedures,
administration of drugs or other such treatments which the veterinarian deems necessary.

I agree to accept responsibility for the full payment of all services rendered at each
visit. If the above animal is admitted to the hospital a deposit equaling no less than half the
estimated cost of treatment will be required with the remainder of the actual cost due upon
discharge. I hereby state that I have read this release and I understand this agreement.