• Central Carroll Animal Emergency

    Central Carroll Animal Emergency

    Estimate Approval
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  • Please initial the statements below to approve this estimate. If your pet is not having a surgical procedure performed, please ignore the third statement. If you are declining this estimate, please skip to the next section.

  • I, , am the owner or authorized agent of the above described animal and I authorize the performance of diagnostic, therapeutic, anesthetic, surgical and preventative procedures listed above or any emergency procedure that may be deemed necessary by the veterinarian. I have been advised as to the nature of the above procedures or operations and of the risks involved. I realize that results cannot be guaranteed. Your initials are giving consent .

  • I, , understand the above quoted cost may vary, depending upon the extent of treatment required. A veterinarian or member of the staff will make reasonable efforts to notify me prior to any additional treatment whe the actual cost is expected to exceed this estimate by 30% unless the additional treatment is required as an immediate life saving measure. Your intials indicate understanding .

  • Surgical procedures, if applicable: I have been explained any surgical procedures that are needed. I understand that any anesthetic procedure carries risks. The veterinarian has gone over possible outcomes and I understand the delicate nature of this procedure. I authorize the veterinarian to perform surgery on my pet. Your intials indicate understanding and consent .

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  • If you decline this estimate, please do not authorize the above statements or enter your signature. If you decline this estimate, please complete the information regarding you and your pet, and then initial below. Please sign your name afterward to decline this estimate.

  • I, , do fully understand that by declining this estimate I am electing services for my pet that do not represent the optimal care as advised by Central Carroll Animal Emergency. The ramification of such a decision on my part may include further deterioration of my pet's condition and/or my pet's death. Your initials indicate understanding and consent

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  • In the event of cardiac arrest, CPR (Cardio Pulmonary Resuscitation) can be performed. This procedure is an additional cost of $237.00 for the first 15 minutes of CPR and does NOT include the estimate described above. If necessary, the attending veterinarian and staff of CCAE have the following permissions for resuscitation:

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