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(360) 385-4488
Mon-Fri: 8am - 6pm | Sat: 8am - 1pm
820 Chimacum Rd | Port Hadlock, WA
Vet Services
Fear Free Approach
Pet Wellness
Pet Dental Care
Pain Management
Pet Diagnostic Services
Pet Surgery
Pet Neuter & Spay Surgery
Pet Vaccinations
Emergency Pet Care
End of Life Services
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Vet Services
Fear Free Approach
Pet Wellness
Pet Dental Care
Pain Management
Pet Diagnostic Services
Pet Surgery
Pet Neuter & Spay Surgery
Pet Vaccinations
Emergency Pet Care
End of Life Services
Meet The Team
Our Veterinarians
Our Staff
Current Clients
Veterinarian Accepting
New Clients
BOOK APPT.
Consent For Treatment
Consent for Treatment
Owner's Name
*
Owner's Name
First
First
Last
Last
Pet's Name
*
Planned procedure
*
Appointment date
*
TATTOO PLACEMENT
You have the option to have a small discreet green line tattooed to indicate that your pet has been spayed/neutered. This tattoo would be on the abdomen or next to the scrotum. In the unanticipated event that your pet should become lost or rehomed, it could save your pet from an unnecessary surgery. This would be at no additional cost to you.
*
Please make a selection
Place a tattoo to indicate my pet has been spayed/neutered
Do not place a tattoo
Please Initial
*
CONSENT FOR TREATMENT
I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.
I have been informed that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate 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. I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication.
The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.
I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.
*
Check Here
Signature
*
signature
keyboard
Clear
Additional Costs
We have done our best to provide you with an estimate of the cost for the procedures we anticipate providing for your pet today. However, during the course of providing treatment, we may find that it is necessary to perform other procedures, run lab tests, use sedation or anesthesia, or prescribe medication to best serve you or your pet which might be over the estimated cost previously presented to you.
Please note: If you check C, we may not be able to do everything needed for your pet’s safety and comfort if we cannot reach you. You acknowledge that if your pet is under anesthesia and we cannot reach you, your pet will be woken up and you will incur additional charges to anesthetize your pet at a later date to complete the procedure(s) needed.
In the event any of these procedures are deemed to be in the best interest of my pet, I authorize the option I marked below:
*
Do whatever is deemed to be in my pet’s best interest
Try to reach me at the number below, but if unable, do what is deemed in my pet’s best interest
Do not do more extensive procedures without contacting me
Contact Information for Today
Name
*
Name
First
First
Last
Last
Phone
*
Date
*
Secondary Contact Name (optional)
Secondary Contact Name (optional)
First
First
Last
Last
Secondary Contact Phone
*
Would you prefer a call and/or text today following your pet's procedure.
*
Call
Text
Both
Current Medications and Supplements
Please be sure and continue all medications prior to surgery, including the morning of. A small meatball of food may be fed to administer medication if needed. If your pet is a diabetic and receives insulin in the morning, please administer ½ the amount of insulin in the morning and with ½ of morning meal unless instructed otherwise by your veterinarian.
Medication
Last Given
Medication
Last Given
Medication
Last Given
Feeding Instructions
Please withhold all food after 10:00pm, but you may continue to offer water. If your pet is a rabbit please do not withhold food or water and bring their normal diet with them.
Time last meal was fed
*
Any other questions or concerns
CPR
Prior to the procedure today we have done our due diligence to ensure that your pet is in good health and has an expectation of a full recovery. We will be conducting another exam prior to the procedure today to assure no changes have taken place since the last exam. Despite these measures, in the unlikely 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 and notified of their status?
By consenting to this service, you are also acknowledging that certain fees will apply. (Treatment cost range of $500-$1000) If you are not able to be contacted immediately, resuscitation efforts will continue or stopped based on the response and prognosis for a successful outcome determined by the veterinarian. Please initial your choice below.
Select one
*
I agree to CPR being performed in case of arrest
I elect a “Do Not Resuscitate” status in case of arrest
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