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Emergency Consent Form

Initial examination (triage) indicates that your pet needs immediate medical care. The cost for this initial care could cost up to $850, and typically includes an intravenous catheter, intravenous fluids, oxygen, basic blood tests, and pain medications.

Please read and select one of the below:

I give permission for immediate medical care and will be financially responsible for the incurred charges on the date of services. I do not authorize immediate treatment and want to speak to a doctor first. I understand that delaying needed treatment could jeopardize the health of my pet.

Pet's Name

Client/Agent Name

Client/Agent Signature

Date

Phone

Questions or Comments