Veterinary Against Medical Advice Form (AMA)

This is a 100% free and printable template for veterinary practices. This form is used to allow the owner to decline any/all medical treatments/procedures and provide a record of the decision. Print it or download it as a PDF.

Veterinary Clinic

Against Medical Advice Form

Today's Date:
Owner's Name:
Preferred Phone #:
Patient Name:
Species & Breed:
Sex:

Recommended Treatment:

Please check the appropriate statements below:

☐I, the owner or authorized agent, acknowledge that the doctor(s) at Veterinary Clinic recommend specific treatments/procedures based on medical needs. Despite this, I am declining all treatments/procedures at this time, fully recognizing this decision is against the doctor's advice.
☐I understand the patient needs further medical attention and it is my responsibility to seek such care. If any adverse issues (including death) arise from declined treatments, I accept full financial and medical responsibility and release Veterinary Clinic, its staff, and agents from all liability.
☐I understand I may return for treatments/procedures later, as this does not end the doctor-patient relationship with my pet.
Owner's Signature:
Staff's Signature:

Download or print this template under the Customize Template section.

An Against Medical Advice Form (or AMA Form) is a document used in veterinary practice to record a client’s decision to decline or discontinue treatment recommended by the veterinarian. It outlines the advised treatment, the potential risks of refusing it, and confirms that the client understands and accepts responsibility for any adverse outcomes.
Veterinarians use AMA Forms to protect both the practice and the client. It ensures there is a clear record that the client has been informed of the recommended treatment, potential risks, and possible consequences of refusal. This documentation helps reduce liability for the veterinary practice and emphasizes the importance of following medical advice to pet owners.
Any veterinarian or veterinary clinic that encounters a situation where a pet owner refuses or discontinues a recommended treatment can benefit from using an AMA Form. This applies to general practitioners, emergency clinics, and specialty veterinary practices alike, as it provides a formal record of the client’s decision.
Common components include: (1) a clear description of the recommended treatment and its purpose, (2) an explanation of the possible risks or outcomes of refusing treatment, (3) an acknowledgment of the client’s informed decision, (4) signatures of both the veterinarian and the client, and (5) the date and any relevant notes about the pet’s condition.

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