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I, the undersigned owner or authorized agent responsible for seeking veterinary care for the animal identified above, certify that I am over eighteen years of age. I authorize North Springs Veterinary Referral Center and its staff and contracted agents to perform medical and diagnostics/procedures on my pet as required for diagnosis and treatment. North Springs Veterinary Referral Center takes all possible care in the treatment and handling of animals, but cannot assume responsibility in the case of fire, theft, or escape. I understand that, as the owner or agent, I am financially responsible for all charges relating to this patient and assume full financial responsibility. I understand these charges will be paid as the services are rendered. I acknowledge that deposits may be required for procedures, hospitalization, or surgical treatment. I have reviewed this patient registration form and provided the most up to date and accurate patient and client information I have available. I have read and agreed to this treatment authorization, the financial obligation, and fully understand the terms and conditions.

I, the undersigned owner or authorized agent responsible for seeking veterinary care for the pet presenting to North Springs Veterinary Referral Center, certify that I am over eighteen years of age. I have read and agreed to this authorization, have agreed to the financial obligations, and fully understand the terms and conditions.

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Signature Certificate

Document name: Emergency Client Intake Form and CPR Directive

Unique Document ID: 35aefe05d83b98250b47a0ee9cd30b1116d128f8

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Timestamp	Audit
October 2, 2025 5:14 pm MST	Emergency Client Intake Form and CPR Directive Uploaded by Administrative Signer - clients@lobadesignstudio.com IP 46.110.111.91

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