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Client Name*

CPR

I am mindful that during the operation/procedure, unforeseen conditions may arise that may require 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.*
In the event your pet should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of your pet’s status? By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitative efforts will continue to be performed at the doctor’s discretion.*

Acknowledgements

I am the owner or an authorized agent for the pet described above and have the authority to execute this consent. By signing this document, I certify that I am over 18 years of age. I agree to make myself available by phone between the hours of 8:00 am – 6:00 pm.

I hereby agree that I have been informed of and understand there are certain risks and possible complications associated with operations and procedures and the anesthesia or sedation associated with those procedures, and after being informed of the nature of the operation or procedures elected by me, I understand what will be done for my pet.

I am mindful that while Grand Central Veterinary Hospital provides the highest quality of anesthesia and surgical services, it is possible that during the operation/procedure, unforeseen conditions may arise that may require the performance of additional procedures deemed necessary by the veterinarian. I fully acknowledge and understand these risks, knowing that the hospital and the hospital staff will do all that is necessary to minimize these risks. Additionally, I authorize Grand Central Veterinary Hospital to perform any such diagnostic, medical treatment, or surgical procedure as deemed necessary for any unforeseen medical or surgical complications if one should arise. I will hold harmless Grand Central Veterinary Hospital, the veterinarian, or any hospital staff members liable for any complications that may or should arise in my pet’s medical treatment and care. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian prior to the procedure taking place.

I authorize the use of appropriate anesthesia and pain relief medications as needed before, during, or after the procedure. I have been informed that there are risks associated with the use of any medications.

I understand the practice of veterinary medicine is not an exact science and thus, there are no warranty or guarantees that can be awarded to me as to the results or cure afforded by the treatments or procedures performed today. I have been awarded the opportunity to discuss any questions I may have regarding the care of my pet to my satisfaction, and it is my responsibility to do so. I accept that my financial obligation remains regardless of any outcome.

I will not hold liable Grand Central Veterinary Hospital, the veterinarian, or any hospital staff members for the loss or damage of any personal items (leashes, collars, blankets, etc.) that are left at the hospital. If I neglect to pick up my pet or any personal items within a 5-day time frame from the date below, Grand Central Veterinary Hospital will assume abandonment of my pet or personal items.

By signing this consent form, I agree to pay in full by the end of business today for services rendered, including those deemed necessary by the veterinarian for any medical complications or unforeseen circumstances. Furthermore, I understand regardless of the outcome of treatment, I am responsible for payment of the procedures performed today. If for any reason there are financial restrictions associated with this visit, it is my responsibility as the owner to notify a staff member immediately of such limitations.

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