I do hereby certify that I am the owner, or assuming responsibility, financial or otherwise, for the animal being presented to Emergency Veterinary Hospital for the treatment of care. I hereby consent and authorize Emergency Veterinary Hospital to receive, prescribe for or treat, as indicated, this animal presented. It is thoroughly understood that I assume all risks. I agree, if appropriate, to pick up this animal at the designated date and time agreed to by myself and Emergency Veterinary Hospital. If in the event that the animal is not picked up, there will be a notice of 10-days to come to claim the animal or it will be considered abandoned. The animal will be held in the manner that is considered to be most appropriate for the animal and the hospital. I understand that pet carriers and personal belongings left for more than 48 hours after patient discharge will be donated to the community or discarded.
I authorize a physical exam for my pet. I understand that the cost of the exam/consultation/emergency fee is $138.70, and that payment is due at time of service. It is understood that I am not released from costs associated with the care of the pet. Emergency Veterinary Hospital does not bill, and all fees are due when services are rendered. Deposits are required for all hospitalized patients. Our Hospital only accepts cash, Visa/MasterCard, American Express, Discover Card, Scratchpay, and Care Credit. I understand that if I do not pay my balance in full, that I am responsible for all statement fees, finance charges, and attorney/collection fees.
I acknowledge that information in this form is true and correct to the best of my knowledge, and hereby authorize Emergency Veterinary Hospital to communicate with and release my pet's medical record to my Family Veterinarian.
If I choose 'YES' to authorize immediate stabilization, I understand that this can incur an additional cost of up to $900. I understand that payment is due at time of service. I also acknowledge that this is simply to stabilize my pet and that additional treatment and/or testing may be needed.
If I choose 'NO' to decline immediate stabilization, I acknowledge that if my pet is experiencing an emergency this will delay the administration of emergency treatment and medications, which may have negative consequences for my pet's health.
If I choose 'YES' to authorize CPR, I understand that CPR will be administered to my pet if needed. I understand that this can incur an additional cost of up to $900 beyond the cost of stabilization. I understand that payment is due at time of service.
If I choose 'NO' to decline CPR, I understand that CPR will not be administered to my pet.