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Refusal of Medical Treatment Form

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Refusal of Medical Treatment Form

Thank you for choosing Creekside Veterinary Hospital! Please fill out this form for refusal of medical treatment. 

I have been advised of the procedures for seeking medical treatment for my alleged work-related injury/illness. By signing below, I am choosing to refuse medical treatment for the above referenced injury. I understand that my signature indicates my refusal of the medical treatment that has been offered to me and that I am completely responsible for seeking medical attention on my own and will pay for any subsequent bills associated with this medical treatment.
Clear Signature
Clear Signature