Treatment Consent Form

I verify I am the owner, or authorized agent for the owner, of the pet named above and authorize the clinic to treat my pet. I authorize the treatment plan that has been discussed with me in addition to the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always a risk associated with any anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. In the event of an emergency (please initial where appropriate),I DO consent to and authorize the performance of CPR and/or altered or additional procedures as are necessary in the veterinarian's professional judgement. I accept responsibility for any result in additional charges which may be $300 - $500 or more depending on the situation.I DO NOT consent to and authorize the performance of CPR and/or altered or additional procedures as are necessary in the veterinarian's professional judgement.I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. I understand no staff will be attending to my pet overnight (pets needing special care may be referred to a 24 hour hospital). If I do not pick my pet up by the time the clinic closes for the day, I understand that I will be charged an overnight fee. Please sign here: