Emergency Vet Services Agreement

  • Client Information

    First and foremost our number one concern is your pet’s health. We ask that clients with elderly pets fill out our Emergency Vet Service Agreement. If your dog needs emergency vet service we will try to get in contact with you, if you are unavailable we will contact your emergency contact. If you have a preference in which emergency vet we take your dog too please let us know.
  • Date Format: MM slash DD slash YYYY
  • Patient Information

  • Date Format: MM slash DD slash YYYY
  • Previous surgeries, cancer treatment, ongoing issues, etc.
  • Primary Care Veterinarian Information

  • Anesthesia & Life Support Consent

  • Some form of anesthesia and/or sedation is required for all surgical procedures. Precautions are taken for each patient as an individual when it comes to anesthesia. Your pet will be required to have preliminary diagnostic tests performed prior to anesthesia/surgery. This may include but not be limited to bloodwork, radiographs, ultrasound, or cardiology consults. You will be instructed as to what tests may be necessary for your pet. Anesthesia is a risk for all patients, no matter their age or breed.

    All patients being treated are required to have a (CPR) Cardiopulmonary Resuscitation or (DNR) Do Not Resuscitate code. In all likelihood, we will not need this information. CPR is the resuscitation of an animal that has stopped breathing or whose heart has stopped. Animals that survive cardiopulmonary arrest and have been successfully resuscitate (CPR) are EXTREMELY critical and unstable.

  • I am the owner or responsible agent for the animal described above and have the authority to execute this consent. I am over 18 years of age. I have read and understand the anesthesia and life support policy and agree. I hereby authorize the use of the appropriate anesthetics and other medication as deemed necessary by the veterinarian. I also authorize the performance of the above life support. I have had the opportunity to ask any questions that I may have regarding the anesthesia and life support policies that were given. I authorize that my credit card information be given to the Emergency Vet at time of drop off.
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.