Consent Form

Save time during your next consent appointment. Complete your required form online from any device before your visit.

Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

Name *

First

Last

Email *

Pet's Name *

Pet's Age *

Phone number at which owner can be reached *

Additional Number

When was the last time pet was fed? *

Anything else needed while pet is under anesthesia?

I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent. *

I have read and understand

CPR/DNR (Resuscitate or Do Not Resuscitate) The vast majority of procedures and hospitalizations have good outcomes and proceed according to plan. In the unexpected event of a sudden decline of your pet’s health, we want to be prepared to respond in a manner that meets your wishes and fulfills your emotional and financial needs. CPR/Resuscitation may include establishment of an airway via insertion of an endotracheal tube, IV catheterization, administration of IV fluids, injections of medications, performing chest compressions, or delivery of intracardiac medications. Animals that have survived cardiac arrest and have been successfully resuscitated are extremely critical and unstable. Management of the post arrest patient requires vigilant monitoring and technical expertise and the outcome is uncertain. PLEASE CHOOSE ONE BELOW

Signature *

Clear Signature

CPR/Resuscitate *

I consent to all costs incurred during the process of resuscitation of my pet. I understand that I will incur charges beyond those included in my agreed upon estimate.
I decline CPR in the event that it is deemed necessary for the survival of my pet. I understand that by signing this “Do Not Resuscitate” order on my pet, the medical staff will not perform CPR or give possibly life-saving medications.

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