135B.27 Admission agreement.Hospital Admission Agreement • March 29th, 2018
The hospital admission agreement signed by the patient or the patient's legal representative shall contain the following statement:
ContractHospital Admission Agreement • December 29th, 2022
ContractHospital Admission Agreement • December 22nd, 2015
AGREEMENT FOR HOSPITALHospital Admission Agreement • March 18th, 2016
The patient and / or representative undersigned hereby authorize hospital admission and / or medical care, in accordance with the following provisions:
ContractHospital Admission Agreement • December 4th, 2021
ContractHospital Admission Agreement • December 22nd, 2017
HOSPITAL ADMISSION AGREEMENTHospital Admission Agreement • November 16th, 2017
Agreement made at Long Branch, NJ on the above date between the Long Branch Animal Hospital at the below address, party of the first part, and the person named above, who represents himself or herself to be the owner of the animal herein described, party of the second part, herein after called the owner.
WESTFIELD ANIMAL HOSPITALHospital Admission Agreement • October 2nd, 2012
Agreement made at Westfield, NJ on the above date between the Westfield Animal Hospital at the above address, party of the first part, and the person named above, who represents himself or herself to be the owner of the animal herein described, party of the second part, herein after called the owner.
ContractHospital Admission Agreement • November 24th, 2020
HOSPITAL ADMISSION AGREEMENT PLAINFIELD ANIMAL HOSPITALHospital Admission Agreement • July 6th, 2005
Agreement made at South Plainfield, N.J. on the above date between the Plainfield Animal Hospital at the above address, party of the first part and the person named above, who represents himself or herself to be the owner of the animal herein described, party of the second part, herein after called the owner.
ContractHospital Admission Agreement • November 24th, 2019
ContractHospital Admission Agreement • May 19th, 2016
HOSPITAL ADMISSION AGREEMENTHospital Admission Agreement • September 30th, 2024
I, the undersigned, do hereby certify that I am the owner (or duly authorized agent of the owner) of the animal identified herein and that I do hereby authorize the above identified veterinary hospital, their agents and/or representatives, to perform the surgical and/or medical procedures, to administer anesthesia, x-ray examination, drugs and/or medications and/or to perform other diagnosis and/or treatment which the attending veterinarian deems necessary.
