• SpeciesBreedSexColorWeight 
  • Anesthetic and surgical procedure(s) to be performed:

    I, the undersigned owner or agent of the pet identified above, authorize the staff of to perform the above procedure(s).

    I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.

    I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. The staff may or may not have my permission to attempt life sustaining procedures (CPR).

    CPR (cardiopulmonary resuscitation) is the attempt to revive an animal that has stopped breathing and/or whose heart has stopped beating. CPR may include chest compressions, positive pressure ventilation, emergency drugs, or other medical interventions. Despite the best efforts of the doctor(s) and staff at EPHR, CPR may not restore the pet’s life. Furthermore, even CPR that restores a pet's life may not allow for the pet to regain normal mental and physical health.

    CPR involves an added financial responsibility of $257.59.

  • While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.

    I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.

    I have read and fully understand the terms and conditions set forth above.

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