Home » Vaccine Waiver Form

Vaccine Waiver Form

"*" indicates required fields

I, the undersigned, understand that vaccinations are an essential component of preventive healthcare for pets. I have been informed by Gibraltar Veterinary Hospital about the recommended vaccines for my pet, as outlined in the vaccination protocol. After careful consideration, I have decided to decline the administration of the following vaccine:*

I acknowledge that by refusing the recommended vaccination, my pet may
be at an increased risk of contracting certain diseases. I have discussed my
concerns with the veterinary team and am aware of the potential
consequences of not vaccinating my pet as recommended.

I understand that Gibraltar Veterinary Hospital strongly recommends the
vaccination protocol to protect the health and well-being of my pet and other
animals in the community.

Reason for Waiver

Please briefly explain the reasons for declining the recommended vaccine(s)*

Acknowledgement and Signature

I, the undersigned, certify that I have read and fully understand the
information provided to me regarding the recommended vaccines for my
pet. I voluntarily decline the recommended vaccine(s) for the reasons stated
above. I understand the potential risks and consequences associated with
not vaccinating my pet as recommended.

Pet Owner's Full Name*

Signature*

Date*

Disclaimer

This waiver is intended to document the client’s decision to decline
recommended vaccines for their pet(s). Gibraltar Veterinary Hospital strongly
encourages pet owners to follow the recommended vaccination protocols for
the health and safety of their pets and the community. By signing this
waiver, the client acknowledges their understanding of the potential risks
associated with not vaccinating their pet(s) as recommended by the
veterinary team.

Phone

This field is for validation purposes and should be left unchanged.