200 SEAWELL ST
SANFORD, NC 27332
919-219-4768
Infinityk9@gmail.com
I _____________________________________________ do authorize Stephanie Parker, RVT, Stacey T. Hathaway,
RVT and employees of Infinity Canine, LLC to perform the following
procedures.___________________________________________________________________
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I acknowledge that both Stephanie Parker, RVT and Stacey T. Hathaway, RVT are registered with the North
Carolina Veterinary Medical Board and Technicians, NOT veterinarians. Under the guidelines of the NC Veterinary
Practice Act, technicians are not allowed to perform any irreversible change or diagnose any issue relating to the
health of the dog, or suggest or provide treatment without direct supervision of a licensed veterinarian.
I further acknowledge that by Infinity Canine, LLC performing the above procedures, this does not guarantee a
pregnancy or puppies to be produced. Infinity Canine, LLC and its employees will not be held liable for a failed
breeding.
Infinity Canine, LLC does encourage all owner to work with his/her veterinarian for progesterone testing, overall
health screen, and brucellosis tests.
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(PRINTED NAME OF OWNER)
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(DATE)
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(SIGNATURE OF OWNER)