Cardiff Animal Hospital & Wellness Center

CONSENT FOR TREATMENT: I, the owner or authorized agent of the admitted patient, direct the staff of the Cardiff Animal Hospital & Wellness Center to administer such treatments and diagnostic procedures as necessary and understand the possible risks involved. I/We understand that the results cannot be guaranteed and that complications could occur.

Initial here indicating consent for treatment *

AUTHORIZATION AND CONSENT FOR SEDATION, SURGERY, AND/OR ANESTHESIA: If your pet is to have an anesthetic procedure, please note that our daily procedure schedule may be rearranged with regards to any admitted or emergency patient(s). Although we request that your pet be here in the morning, procedures are performed throughout the day. We will call you when your pet's procedure has been completed.

I authorize the Cardiff Animal Hospital & Wellness Center to perform sedation/general anesthesia and the recommended procedure/surgery on my pet. I understand that all sedation/anesthesia/surgery involves risk, which may include unsuccessful results, complications, injury, or even death, from both known and unforeseen causes and no warranty or guarantee is made as to the result or cure. The Cardiff Animal Hospital & Wellness Center will not be held liable or responsible in any manner whatsoever, or under any circumstances, as it is thoroughly understood that I assume all risks.

Initial here indicating authorization for sedation, surgery, and/or anesthesia *

AUTHORIZATION FOR LIFE-SAVING TREATMENTS: An unforeseen medical condition may occur at any time and result in a patient going into cardiac or respiratory arrest.

If my pet’s health deteriorates and cardiopulmonary resuscitation (CPR) is necessary, I want the following to occur: *

Provide cardiopulmonary resuscitation (CPR) for my pet. I understand there will be additional charges for this service. CPR fees start at an additional $750, in addition to whatever services were rendered up until the time of arrest. DO NOT resuscitate. Do not intervene with any life-sustaining care for my pet.

Initial here to confirm your selection for or against CPR *

COST FOR TREATMENT: The treatment plan does not guarantee the total cost of services provided to your pet. The treatment plan is an attempt to predict the course of the patient’s veterinary care and represents a BEST APPROXIMATION of the cost to provide care based on the known condition of your pet at this time. However, the actual cost may vary due to unforeseen procedures or medications that are deemed necessary to achieve the best results of the procedures/treatment or due to changes in your pet’s condition. Our primary concern is providing your pet with the best care. We will strive to keep you informed of any changes which may cause the estimate to be exceeded, but for various reasons, this is not always possible.

Initial here to acknowledge cost of treatment *

RECHECK EXAMINATIONS, ONGOING THERAPY, and FOLLOW-UP DIAGNOSTIC TESTING: In addition, I understand that this treatment plan for services does not include charges for future follow-up visits. Follow-up diagnostic procedures, such as laboratory tests and radiographs, as well as sedation or general anesthesia, if required, will be additional and must be paid at the time of those visits.

Initial here to acknowledge treatment plan provided does not include any future services *

INITIAL DEPOSIT FOR TREATMENT/CARE OF HOSPITALIZED PATIENTS: I understand that I must leave a deposit for the diagnostic and treatment plan provided for my pet. Payment equal to the low-end estimate of the treatment plan is required upon admission of my pet to the hospital. I further understand that I will receive regular financial updates and that payment of additional charges may be required during my pet’s hospital stay. I understand that payment is due IN FULL at the time of discharge.

Initial here to indicate agreement of required deposit *

PAYMENT DUE AT THE TIME OF SERVICE AND FORMS OF PAYMENT: Payment for all services are due at the time services are rendered. At your request, we will gladly discuss the cost of all services and/or prepare a written estimate of costs for all recommended treatment(s) or services.

ACCEPTED FORMS OF PAYMENT: We accept payment in the form of cash, Visa, Mastercard, and Discover. We DO NOT accept American Express or checks.

THIRD PARTY FINANCING: In addition, we also accept third party financing options for our clients via Care Credit and Scratchpay.

SPECIAL CARE CREDIT CONSIDERATIONS: (1) We only accept the 6-month term with Care Credit. (2) Care Credit requires that payment only be made for services as they are rendered, we therefore cannot charge services to your account in advance. (3) The use of Care Credit requires that the card and card holder be present at the time of payment, and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

As financing options are available, we do not offer any payment plans for our services.

Initial here to indicate agreement to payment due at time of service and forms of payment accepted *

I have read and understand the above authorization and consents, and I assume financial responsibility for all charges, regardless of outcome. *

Client First Name Last Name

Client or authorized representative signature *

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Pet's Name *

Today's Date *

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