I, (name, fill below) the undersigned owner or authorized agent for the owner of (pet name, fill below), acknowledge that I decline one or all of the following: pursuing diagnostics, treatment, medications, or any other medical advise given to me per the attending doctors' recommendation. It was explained and recommended to me to pursue these diagnostics, treatments and or medications. Without proper testing, treatment, or medications it could cause potential problems for (pet name, fill below) in the future. I fully recognize that my decision is against the attending doctor's recommendations. I accept full financial and medical responsibility for my decision and hereby release the staff at this veterinary practice of all responsibility and liability for that choice.