Client Responsibility Form

Client Responsibility and Release for House Call Appointments:

Our mobile practice allows for a decreased stress level for the pets and decreased time
commitment for the clients. If patients must be chased, caught, dragged, or extracted, the
potential for human and animal injury rises and the stress level is very high. This is also a
waste of client and veterinarian time.

It is the responsibility of the pet owner to confine or restrain their pets prior​to our arrival.
Cats must be in a carrier or closed in a bathroom or small room with no furniture to hide
under. Dogs must be on a leash and not loose in the yard or house.
Housecall fee will be assessed if the following occurs:

  • The patient cannot be obtained within 15 minutes of arrival
  • All services are refused after we arrive for the appointment
  • No one is home for the scheduled appointment

We appreciate our clients who already understand and abide by these requirements.
Please read and sign below acknowledging your understanding and acceptance of these

I understand that animals can be unpredictable; therefore, I assume full responsibility for any
damage done by any of my pets to my family or my property. I further agree to cooperate with
Dr. Dismukes or any of her assistants with whatever restraints she deems necessary as part
of the examination or treatment of my pet(s). This includes services authorized by co­owner
or other persons present for the appointment. I understand that any procedure carries some
risk and that it is not possible to guarantee the successful outcome of any such procedure.
This agreement will remain in force indefinitely from this date unless I notify MLVS in writing
requesting to cancel the agreement.