I hereby authorize the veterinarian on duty and assistants the doctor may designate to administer treatment as is considered necessary. The reasons such treatment is considered necessary, its advantages and possible complication, and possible alternative treatment will be explained to me by the doctor. I also certify that no guarantee has been made as to the results that may be obtained. I consent to release all medical information. I hereby certify that I have read and understood the above Authorization for treatment.

Professional Fee Policy: The fee for the emergency examination by the veterinarian is $150.00. An additional $25.00 fee will be added from 12:00 AM to 8:00 AM. Holiday examination fee is $175. Additional fees are charged if treatment, medication, or hospitalization is necessary. An estimate of total cost may be obtained from the veterinarian. A deposit may be requested. Fees are to be paid at time of service.

Cardiopulmonary Resuscitation Status Election Form

ln the event your pet experiences a respiratory or cardiac arrest while in our care, cardiopulmonary resuscitation (CPR) can be administered based on the medical judgement of the veterinarians at Pet Emergency Clinic & Referral Center. CPR includes but is not limited to chest compressions, insertion of a breathing tube with manual ventilation, and administration of emergency drugs. The success of CPR depends on how advanced your pet's condition is.

By signing below, I am indicating that I am the responsible owner/agent for the patient. I am also certifying that I am above 18 years of age. I also acknowledge that if I wish to change my patient's resuscitation status in the future, I will be asked to do so in writing.