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I authorize the release of my pet's previous medical records to Tell Tail Moonlight Veterinary Center. I, the undersigned, grant permission for the veterinarians and staff at Moonlight Veterinary Center to conduct any necessary examinations, diagnostics, treatments, and/or surgeries for my pet. I understand that while every effort will be made to ensure my pet's health and safety, all procedures carry some level of risk. I acknowledge that no guarantees regarding treatment outcomes have been provided and agree to adhere to the treatment plan and recommendations from the veterinary team. I confirm that I am at least 18 years old and fully authorized to make decisions regarding the care of the pet(s) listed on this form. I understand that payment is due at the time services are provided. Moonlight Veterinary Center accepts cash, credit cards, Care Credit, Scratchpay, and debit cards. I agree to pay in full for all services, medications, and products at the time of service unless alternative arrangements have been made beforehand. In the event of non-payment, I understand that Moonlight Veterinary Hospital may pursue collection of any outstanding balance through legal means. Tell Tail Veterinary Inc. is required by law to request your date of birth in order to legally prescribe controlled substances for your pet, should a veterinarian determine it necessary. This information is kept confidential and is used solely for reporting dispensing information to the Department of Justice. According to Business and Professions Code Section 4170 and Health and Safety Code Section 11190, all licensed professionals who dispense Schedule II, III, and IV controlled substances must report this information to the Department of Justice on a weekly basis. – Veterinary Medical Board of California
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