Full Legal Name as written in passport/government ID

If different from registered address. If you do not have your house number/building easily displayed please include description such as colour of building or house etc.
Please note that this request is subject to the vet's approval and supply stock.
You can also use this space to add more meds to your order.
Click or drag files to this area to upload. You can upload up to 2 files.
Upload Prescription
Please note that this request is subject to the vet's approval and supply stock.
You can also use this space to add more meds to your order.
1. I am the owner (or authorized agent) of my pet. I hereby authorize and direct Eco Planet Ltd T/A The Mobile Vet Company; its veterinarians, technicians, and assistants to perform services, vaccines, treatments, diagnostics, and/or administration of extra label medications as deemed necessary or advisable in connection with or relating to the matters described in the attached estimate or the matters that have otherwise been explained by Eco Planet Ltd T/A The Mobile Vet Company; veterinarian or other staff.
2. I understand that there is a risk of complications with every procedure, including the possibility of death as a severe complication of surgery, anesthesia, or other procedures. I also understand that there is no guarantee as to the results of any procedures, diagnostics, vaccines, or treatments. I understand that I may ask any questions that I have regarding any procedure, diagnostic, vaccination, or treatment recommended by Eco Planet Ltd T/A The Mobile Vet Company; veterinarian before it is performed.
3. I authorize Eco Planet Ltd T/A The Mobile Vet Company to obtain all medical records regarding my pet from other veterinary hospitals as needed.
4. I understand that Veterinary Technologists/Veterinary Technicians/Veterinary Nurses/Veterinary Assistants may perform certain functions in the preparation and care of my pet even when a veterinarian is not present
5. I understand and agree that portions of my visit or the care and treatment of my pet may be recorded for security purposes.
6. I understand that payment is due in full at the time that services are rendered. If for any reason payment is not made at the time services are rendered or within ten days after, I understand that my account may be referred to a collection agency. In the event that my account is referred to a collection agency, I agree that Eco Planet Ltd T/A The Mobile Vet Company may add an amount to my outstanding account balance to reimburse Eco Planet Ltd T/A The Mobile Vet Company for the reasonable collection charge imposed by the collection agency. Eco Planet Ltd T/A The Mobile Vet Company does not request or require personal information as a condition to payment by credit card, but card users may be required to provide proof of identity.
7. Eco Planet Ltd T/A The Mobile Vet Company provides a mobile clinic for house call examinations and treatments to be performed in. If I request an examination and/or treatment be performed in my household Eco Planet Ltd T/A The Mobile Vet Company, its veterinarians, technicians, and assistants are not responsible for damage to property or personal items which may occur during the course of said visit.
8. Professional restraint will always be provided by Eco Planet Ltd T/A The Mobile Vet Company veterinarians, technicians, and assistants. If I refuse the professional restraint of my pet provided, Eco Planet Ltd T/A The Mobile Vet Company and its veterinarians, technicians, and assistants are not responsible should I be injured by my pet.
9. I understand that there is a risk of reaction with any vaccination. Vaccination reaction symptoms can range from mild to severe anaphylaxis or even death. If my pet requires emergency treatment for a vaccine reaction I authorize Eco Planet Ltd T/A The Mobile Vet Company to provide medical care and treatment they deem necessary and understand that I am responsible for the cost of said emergency care and treatment.

**PLEASE NOTE: Due to the nature of our business operation, the Mobile/Booking Fees for missed (including missing pets and pet guardians), late, cancelled or rescheduled appointments will be billed as a cancellation fee of $50.Please ensure you and your pet are present for your confirmed appointment. 24 hours required.