Day Admission Procedural Informed Consent Form  Logo

  • Day Admission Procedural Informed Consent Form

    Thank you for choosing Highland Veterinary Clinic. We're here to provide compassionate, innovative, excellent care. Your pet is scheduled for a day admission where we are to perform examination, diagnostic procedures and/or veterinary treatments. We strive to provide excellence in veterinary and nursing communications, but we understand that procedures involving your pet without your presence can create stress on pet owners. To communicate effectively, and ensure that your pet's admission process is as low-stress as possible for you and your pet, we created a required online informed procedural consent form, which will allow for you communicate with us effectively, submit your form in advance, and to focus on your pet during admissions day. We require this form to be completed, signed and on file prior to admitting your pet for any procedures. We will attach a copy of these responses to your pet's record and can provide a printed copy at your request. Day admissions are scheduled by prior arrangement Mon-Wed and Fridays, and admission time is 7:30-9am on the day your pet is scheduled. If your pet may require sedation or special handling, please do not offer solid food after 9pm the night before (water is just fine) and specify any medications or foods your pet takes.  If your pet has diabetes or hypoglycemia risk, we will be happy to discuss their special needs with you. Alternatively, we can schedule one free pre-admission boarding night at no cost to you if your procedure or treatment is to be completed the following day  (this generally is a wonderful idea for dogs undergoing heartworm treatment).
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  • PATIENT INFORMATION, HANDLING, VACCINATION STATUS, & CONDITIONS

  • I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.

    I have been informed that there are certain risks and complications associated with sedation, anesthesia, as with any veterinary procedure and that the risks/complications have been explained to me. I further understand that during the course of the sedation-related procedure, or veterinary treatments, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated.

    I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment. I authorize the use of appropriate sedatives, anesthesia and/or pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication. 

    My signature below FUTHER VERIFIES that my pet has NOT/will NOT eat any food after 9pm the night before my pet's sedation related procedure, and will only take in clear liquids by mouth.  I understand that failure to comply with this instruction can result in serious harm or injury to my pet, their GI tract, and their airway when sedated or given anesthetic drugs.

     

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  • Diagnostic, Treatment or Procedural Consent & Financial Responsibility



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  • Financial limitation or estimate request (optional): While I understand and am financially prepared for the fact that examination fees range up to $50 for a routine physical exam and $65 for an extended or urgent care examination, please contact me after this initial assessment, if my pet is in a stable condition, in the manner I have requested above, for further authorization if diagnostics or treatments in your plan of care are anticipated to exceed
    $ so I can discuss further services with a technician or veterinarian and make an informed financial and veterinary decision for my family.

  • The nature of the aforementioned veterinary care or procedures has been explained to me and I understand what will be done.  I am aware that the practice of veterinary medicine is biological in nature and while standard of care is practiced within this veterinary facility, exact science in the medical arts cannot be guaranteed, and thus, there are no statistical guarantees for successful treatment outcomes. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction.  I accept that my financial obligations for authorized diagnostics and treatment remain, regardless of medical success of the outcome. 

    I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.  I also assume financial responsibility for all charges incurred to the patient, and agree to pay all such charges at the time of release of the patient.

    I further understand that In the event of nonpayment, fraudulent payment, bounced checks, or any violation of any prior agreed payment arrangement, the entire balance shall be considered in default with the addition of any and all banking, collection fees, collection agency and/or attorney fees, necessary to the amount due to Highland Veterinary Clinic without any relief whatever from Valuation and Appraisement Laws. I further understand that my check may be presented electronically at any time for validation or deposit.

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