Treatment Authorization
I am the owner or an authorized agent for the owner of the above-named pet. I have the authority to make medical decisions related to the pet. By signing this Patient Intake Form, I hereby authorize the doctor on duty (and staff the doctor may designate) to administer treatment and medication as is considered therapeutically or diagnostically necessary or appropriate on the basis of findings during the course of evaluation of the above-described animal. I acknowledge that the emergency examination fee is $195. I consent to the release of medical information by EAH. EAH is open 24 hours per day, 7 days per week. I agree that any patient not so removed shall be deemed to have been abandoned. Once this animal has been abandoned, EAH has the responsibility for the animal and will treat or dispose as we deem best. I understand that my animal will receive emergency treatment only and that it may be released before all medical problems are known or treated. I understand that, with any medical or surgical procedure, there are risks involved, including the risk of death. I acknowledge that no guarantee or assurance is being made as to treatment results.
Acceptance of Financial Responsibility
I understand that payment in full is required at the time of service. I understand that EAH staff will provide me with an estimate for recommended services, and acknowledge that it is my responsibility to notify the staff of any financial limitations I might have, so that they are able to tailor the treatment plan accordingly. I acknowledge that an estimate is only an approximation. If the pet requires hospitalization, I agree to make a deposit in advance and pay the balance when the pet is discharged. If I do not pick up the pet at the date and time specified by EAH staff, additional charges will accrue. I recognize that I am responsible for all charges related to the pet, regardless of treatment results and treatment results are not guaranteed. I agree to make payment in cash or by American Express, Visa, MasterCard, Discover, Care Credit, or ScratchPay. I am aware that all delinquent accounts will be transferred to a collection agency.
AI Dictation Consent
To support accurate, timely, and complete medical records, our hospital utilizes a medical dictation software called Talkatoo. This technology is used to document medical findings, treatments, and relevant communications, including in-hospital discussions and medically relevant phone conversations that occur as part of your pet’s care.The use of this software allows our veterinary team to efficiently create medical records while maintaining focus on patient care. Talkatoo securely processes dictated information to generate medical record text and does not replace the professional judgment of our veterinary staff.By signing this form, you acknowledge that you have been informed of, and you consent to, the audio recording and use of Talkatoo for the creation and maintenance of your pet’s medical record during their care at our hospital.