CPR/DNR Form

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Pet Name*

Resuscitation of an animal that has stopped breathing but still has a heartbeat is more likely to succeed than on an animal that is not breathing and has no heartbeat. Animals that survive a cardiopulmonary arrest and have been successfully resuscitated (CPR) are extremely critical and unstable. Management of the post-arrest patient requires vigilant monitoring and the technical expertise of dedicated critical care personnel.

This estimate is for the initial CPR. An estimate for further care will be provided to you as your pet stabilizes. Typical CPR CRITICAL CARE for the first 24-48 hours post arrest is estimated to be $1500-$3500 dependent on your pet’s injury or condition.

CPR (RESUSCITATION) should be performed on my pet if my pet suffers from cardiac or respiratory arrest.*

Yes, perform CPR/resuscitation ($500-$800)No, I do NOT wish to have CPR/resuscitation

PAYMENTS ARE DUE AT THE TIME SERVICES ARE RENDERED.

Please sign below to indicate that you have read and understand the options of CPR or DNR presented above.

Signature for Authorization*

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