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Number of Pets
PET HEALTH HISTORY
I hereby authorize the veterinarian to examine, treat and prescribe for the above described pet.
I assume responsibility for all charges incurred in the care of this animal. I also understand that all
charges must be paid at the time services are rendered and that a deposit may be required for surgical
treatment or hospitalization.
4340 E. Broadway Blvd.
Tucson AZ 85711