Central Carroll Animal Emergency Estimates

Central Carroll Animal Emergency

Estimate Approval
Date

Month Day Year
Date
Time

: Hour Minutes AM/PM Option
Name

First Name Last Name
Phone Number

Area Code Phone Number
Pet Name
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.
Signature
Please enter your full name to authorize this estimate.
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 enter your full name afterward to decline this estimate.
Signature
Please enter your full name to decline the provided estimate.
In the event of cardiac arrest, CPR (Cardio Pulmonary Resuscitation) can be performed. This procedure is an additional cost of $230 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:
Please select:

No, please don't make any attempts to resuscitate my pet. Yes, please perform CPR on my pet immediately and contact the owner/agent for further instruction. In the event my pet is unable to sustain life on his/her own (without the help of CPR or extreme life-saving measures), I request that CCAE humanely euthanize my pet.
Signature
Please enter your full name to consent to the above choice.
Should be Empty: