CPR Form

CPR/ Resuscitation Form
If my pet experiences unexpected life-threatening conditions while under the care of Norhtpark Animal Hospital such as but not limited to cardiopulmonary arrest while hospitalized or under anesthesia:
I understand that CPR is not guaranteed to restore life and may result in additional charges.

I understand that emergency treatment may result in additional charges.

I authorize the use of appropriate sedatives, anesthetics, oxygen, and other medications and understand there is always some risk involved in the use of these agents.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Client Signature
Witness Name

Employee Name Date
Should be Empty:

CPR/ Resuscitation Form