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Hospital Consent To Treat
Owner Details
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Pet Details
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PLEASE CHOOSE ONLY ONE TO AUTHORIZE
I authorize the attending veterinarian to perform any procedures deemed necessary while my pet is here. I am aware that I will be responsible for any and all costs which will be due at discharge.
I authorize the attending veterinarian to perform any procedures deemed necessary up to $____________. Anything beyond this cost please contact me to discuss treatment and further costs.
Please contact me with a medical treatment plan before proceeding with any treatment not already discussed. If I am not available, do not proceed. I understand this may mean I need to bring my pet back at another time for diagnosis and treatment.
In the event of cardiopulmonary arrest (loss of heartbeat and breathing), I understand that I will be contacted to discuss options of care. Until I can be reached, I authorize the following (PLEASE SELECT ONE):
CPR (CARDIOPULMONARY RESUSCITATION)
DNR (DO NOT RESUSCITATE) Resuscitation efforts should NOT be made.
As the owner (or authorized agent for the owner) of <animal>, I do hereby consent and grant the veterinarian(s) of Trident Veterinary Hospital and all of their employees, agents, servants, and/or representatives (collectively, the “Hospital”) full and complete authority to perform the procedures and treatments described above and to perform any other procedure or treatment that, at the attending veterinarian’s discretion, may be deemed medically necessary for <animal>, and I do hereby forever release and discharge the Hospital from any and all liability arising from such procedures and treatments.
I understand that all fees associated with the above authorized care are expected to be paid in full at that time of pick-up.
I do hereby consent and agree that photographs and digital recordings of my pet obtained during hospitalization may be used for the purpose of medical case reports, education presentations and advertising purposes. Client confidentiality will be maintained
I accept and agree to the terms above
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