Petco 1319
Visit Consent 5406 Pacific Ave
Stockton, CA 95207
VetcoClinics.com
Pet Information
Pet Name: Biscuit Date of Service: 10/20/2024
Consent
Client Consent to Services
Lifestyle Assessment
I acknowledge that I have reviewed the lifestyle assessment, I am at least 18 years old, and I am responsible for the services
selected/not selected for my pet.
Vaccine Information
I understand that vaccinations and parasiticides will substantially reduce, but may not completely eliminate, my pet's chances of
contracting or controlling the illnesses or parasites we are trying to prevent. No refunds, substitutions, alterations or additional
discounts allowed for packages. Your vaccine package purchase is eligible for 4 months of redemption. For the most
protection, pets should receive boosters at specified intervals. If interval timeframes are exceeded for boosters, your
veterinarian may recommend additional boosters outside of the package and those will be administered at the client's expense.
Side Effect
I understand that my pet may develop side effects after vaccination and/or administration of parasiticides and that these side
effects are usually minor and resolve without need for additional veterinary care. Common side effects may include:
Lethargy/Depression/Sleepiness
Decreased Appetite
Limping/Soreness over Vaccination Site
Antisocial behavior (cats and some dogs)
Small Swelling at/over Vaccination Site
If you are concerned by any behavior or symptom your pet exhibits after the administration of a vaccine or parasiticides, contact
our Customer Service Department at 877-838-7468. If any symptoms persist for over 48 hours, please contact your
regular veterinarian. I understand the toll-free Customer Service line is not staffed by veterinarians and therefore they cannot
diagnose, treat or advise me in any event concerning the health of my pet or its symptoms/behavior. However, it is
recommended that I report any suspicious symptoms/reactions so they can be properly reported and monitored.
I understand that should my pet develop any severe, reaction or any behavior/symptom that is of concern to me emergency
veterinary care may be necessary and it is my financial responsibility to seek care at the nearest veterinary facility.
CATS ONLY: Malignant Cancer at injection site
I understand that in addition to the side effects described above, following the administration of any vaccine, my cat may
develop an aggressive, malignant cancer at the injection site. I understand that if my cat develops this cancer all veterinary costs
incurred for the diagnosis and treatment are at my expense.
Heartworm Testing and Prevention - Test Valid for 30 Days
Your pet's heartworm test result is valid for 30 days. Prevention must be started or continued within that time. Annual testing is
required to be able to purchase heartworm prevention products. I understand that I can purchase heartworm prevention
products through Vetco Clinics, or the pharmacy of my choice. I agree that I will not give heartworm prevention without a
negative test result.
Written Prescription
A written prescription for any prescription product is available upon request.
Acceptance of Risk
To the best of my knowledge, I confirm that my pet has no sign of disease, is not allergic to vaccines or parasiticides and is not
pregnant. I have read and understand all the provisions as well as the listed possible reactions, and I have had the chance to ask
any and all questions that I have regarding the risks associated with vaccinations and parasiticides that have been
recommended for my pet based on a discussion of my pet's lifestyle and risk.
I agree to accept all risks of vaccination and parasiticides and accept legal and financial responsibility for all charges incurred as
a result of such risks. I further acknowledge that Vetco Clinics, or any of their veterinarians, owners, subcontractors, staff, or any
other individuals or entities associated therewith, will not bear any legal or financial responsibility for such risks and will not bear
any legal or financial responsibility for any charges or losses incurred by me.
Consent for Disclosure and Use of Information
By signing below, I consent to and authorize the collection, retention, use, sharing, and disclosure of my personal information
(including my name, address, telephone number, email address), and the name of my pet(s) and their vaccination and medical
information, by Petco Animal Supplies Stores, Inc. and its related entities and affiliates ("Petco") for commercial purposes.
Petco's commercial purposes include, without limitation: providing treatment services to my pet (including to record my pet's
health information and receive payment); determining needed treatment services, treatment alternatives or other pet health-
related issues; sending vaccination reminders; fulfilling online orders, prescriptions, or requests; notifying me of product recalls;
administering and improving Petco's websites and businesses; promoting Petco's products and services, or third-party products
and services that I may find of interest; communicating with me about contests, sweepstakes and other promotions, and
conducting other marketing activities; responding to my inquiries and correspondence; and requesting feedback. By signing
below, I consent to and authorize the disclosure of my personal information to: any related entity or affiliate of Petco; Petco's
third-party service providers or contractors; government regulators and vaccine manufacturers; other veterinary services
providers if doing so is helpful or appropriate for facilitating treatment (such as in the case of a referral for emergency services
due to an adverse vaccination reaction); and to other third parties as part of a merger, acquisition, change of control or other
sale or transfer of any assets or business of Petco. Petco's Privacy Policy may be accessed at www.Petco.com/privacy-policy.
I hereby give my consent to proceed with the recommended vaccinations, tests and antiparasitics for my pet.
Printed - 10/20/2024
