Types of common illnesses treated
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I Confirm that the information furnished by me above is true and correct, and I further submit that the above-mentioned address, contact number, email address and ID number is my chosen domiclium addresses for the purpose of service of any invoices, statements, notices and/or legal documents.

I hereby give consent to make use of my "personal information" in terms of the Protection of Personal Information Act adopted by the Republic of South Africa on 26 November 2013 which refers to information pertaining to an identifiable, living, natural person, and where applicable, an identifiable, existing juristic person. Whereas, in terms of POPIA, "processing" of personal information includes, for example, the collection, receipt, recording, storage, modification, use, distribution, merging and erasure of personal information.

In the event of any grievance or dispute with this veterinary facility or its veterinarians, I undertake to enter and complete the VDA’s free Alternate Dispute Resolution process, before resorting to any other action remedy.

I hereby give consent that photos/videos may be taken of my pet and used anonymously for Exotic Vet Century City’s social media page(s).

I hereby agree to receiving any marketing material sent to me by Exotic Vet Century City.


I acknowledge that I am indebted to the above practice for veterinary treatment, services rendered, and expenses incurred therewith and hereby render myself responsible for all costs, telephone calls and legal expenses, as between attorney and own client including collection charges that may be incurred in the recovery of the outstanding amount.

I confirm that I acknowledge that all accounts in respect of the services rendered to me are due and payable within 30 (thirty) days from date upon which the service was rendered to me and that the information supplied by me will be used to communicate said account(s) to me.

I confirm that I accept that mora interest will be levied on amounts outstanding for more than 30 days from date of statement at today’s prescribed mora interest rate in terms of the Prescribed Rates of Interest Act 55 of 1975.

Should legal costs be incurred by the practice because of my non-payment, I acknowledge that these are for my account, at attorney and client rate. Should it become necessary to institute legal proceedings against me for recovery of any amount due, I agree to pay all costs on the scale as between attorney and client, including tracing fees and collection commission + VAT thereon.

I have arranged appropriate insurance cover for any loss or damages of whatsoever nature that may arise from this, alternatively, I accept that I self-insure for any such loss or damages.

I confirm that I am aware that the account is to be settled in full at the time of discharge from the hospital.

I understand that my pet will not be discharged from the clinic if my balance is not paid in full. A R250 per night boarding fee will be charged until the balance is paid. Any bill not settled within 72 hours of surgery will be considered abandonment of your pet and they will be released to the proper authorities.

I understand that any estimate given to me (verbal or written) is an estimated value, not a quotation, and the actual treatment cost may exceed this. The estimated fee does not cover any complications that may arise, these fees will be charged additionally. Revisit fees and continued treatment are not included in the estimate.


I, the undersigned, an adult major, hereby authorize the veterinarians and staff of this veterinary facility to perform any reasonable treatment/anesthesia and surgery they may deem necessary, including further or alternative measures as may be necessary during the surgery and/or treatment of my animal.

I am aware that this veterinary facility does not provide 24-hour per day monitoring of patients. Should I wish to have my pet monitored 24 hours per day while hospitalised, I will make arrangements with the staff of this facility. I undertake to keep in daily contact to enable the staff to inform me of the progress, costs incurred, and additional treatment involved, of my hospitalized animal.

I recognise that there is some degree of risk attached to any medical or surgical procedure or treatment. I have discussed any concerns I may have with the veterinarian. I hereby absolve the veterinarians, staff and this facility from all actions, arising directly or indirectly from the treatment / anesthetic / surgery.

While the veterinarians at this facility provide diagnosis, treatment, and prognosis to the best of their ability, economic constraints prevent these from being made with all the necessary information example, the collection, receipt, recording, storage, modification, use, distribution, merging and erasure of personal information.

I am fully aware that post-mortems of deceased animals will be undertaken for further diagnostics investigation and educational purposes on a case-by-case basis.

If an owner of a patient has not made contact with the practice after 5 days, it will be considered as abandonment of the animal, and they will be sent to the proper authorities.

All small personal items left at the practice with the animal will be considered lost, as all items will go through the washing system and finding it again is impractical.

Any carriers not collected within 7 days of account closure will be considered abandoned and will be donated to rescue organisations.


I understand that there are often no suitable products that are specifically registered in South Africa for use in a particular species of animal or for a particular medical condition in that species of animal.

Understand that, in order for my veterinarian to be in a position to treat my animal, he/she may have to resort to using or advising the use of products registered for use only in other species, including human beings, and/or products registered for another purpose.

Understand that treatment with the products will mean that my veterinarian will be using or advising the use of such products on my animals outside of the recommendations or even in contradiction with the recommendations contained in the package insert relating to the registration of that product (i.e., “off-label”).

Accept that there may be known, or unknown side-effects and adverse consequences associated with the use of these products under these circumstances, have apprised myself of these risks and unconditionally accept the risks related thereto.

I unconditionally indemnify the veterinarians of this facility, the facility, and the staff of the facility against any claim of whatsoever nature arising from any side-effects or adverse consequences or any damages that arise from the use of the products