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Home » CONSENT: Sedation/Treatment

CONSENT: Sedation/Treatment

Client(Required)

Email(Required)

Patient Profile

Name(Required)

Breed(Required)

Weight(Required)

D.O.B.(Required)

Type

Sex(Required)

Male

Female

Neutered

Spayed

Thank you for reading through this message, and for trusting us.

The Community Pet Healthcare Team

Prior to pet treatments, please fill out this sedation/treatment consent form.

What supplements, OTC medications, and/or prescription medications does pet receive? You can also take pictures and send them in this chat (after completing this form)

Have you reviewed and approved the treatment plan/healthcare plan for pet and understand that you are responsible for payment in full upon discharge?(Required)

Yes, I have reviewed the healthcare plan and consent to this procedure for my pet.

I have not reviewed the healthcare plan or I have questions. I need to speak to the nurse/doctor more before my pet undergoes this procedure.

Does pet need any additional services while with us today? (please select all that apply)

Ear Cleaning

Anal Gland Expression

Nail Trim

Although not anticipated, should unexpected life-saving emergency care be required I would like the hospital staff to attempt the following life saving measures:(Required)

CPR, Cardiopulmonary Resuscitation

DNR, Do Not attempt Resuscitation

As the owner of the above named pet, I certify that I am over the age of 18; and I authorize the staff of this hospital to perform the treatment(s) from the healthcare plan, as well as those deemed necessary to treat life-threatening emergencies.(Required)

I acknowledge that staff members at this practice have explained the procedures to me, answered questions to my satisfaction and cannot be held responsible for any unforeseeable results. Further, I understand that I am financially responsible for all costs incurred during this surgery, treatment, and hospitalization and that payment is due at time of discharge.

While I accept that all procedures will be performed to the best of the abilities of the staff at this facility, I understand that veterinary medicine is not an exact science and that no guarantees have been made regarding the outcome of this/these procedures. I have read and understand the nature of the above procedures and accept the specific terms and conditions set forth herein.

In the event my pet is hospitalized beyond the first day at this facility, I understand that veterinary care during nighttime hours and/or weekends is provided at the discretion of the attending veterinarian. Continuous presence of personnel may not be provided during these hours. If I desire that my pet have supervision when this facility is closed, I will have him/her transferred to a local emergency clinic where overnight veterinary supervision is available at my expense.

Please sign your name to verify you have read and completed the above form.(Required)

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317-344-0906

11812 Sylo Crossing,
Zionsville, IN 46077

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CONSENT: Sedation/Treatment

Patient Profile

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care