Stabilization/Critical Care Form

Stabilization/Critical Care Form
Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Pet Name *
Your pet has been presented in a CRITICAL or LIFE THREATENING state. In order to provide quick, clear communication and focus on the care of your pet, please authorize a care plan.
Critical Care Plan Options *

Yes, perform critical care stabilization ($600-$975) No, I do NOT wish to have critical care treatment
PAYMENTS ARE DUE AT THE TIME SERVICES ARE RENDERED.
Signature for Authorization *

Clear
Should be Empty: