ABC Veterinary HospitalSpecialty Ultrasound Booking Consent Form

Book an Appointment

Specialty Ultrasound Booking Consent Form

Owners Name *

First

Last

Pet's Name *

Procedure(s) to be performed:   *

Date of Procedure to be Performed: *

The phone number(s) where you can be reached today:

Phone 1: *

Phone 2: *

Section Divider

Booking Deposit Acknowledgement: *

I hereby understand that upon scheduling I am to pay a $200 deposit that is non refundable if canceled within 48 hours of scheduled appointment. If canceled within that window, the entire deposit will be forfeited. I understand my pet needs to be dropped off 2 hrs before the scheduled window for specialty service, this will be relayed from ABC Veterinary Hospital Staff.

Drop Off Consent Waiver:

As a full service veterinary hospital, we are pleased and proud to offer you the best medical care available to your pet. Your pet's health is of utmost priority to our dedicated staff, and we take all possible precautions to ensure their safety and comfort. With every pet that will be placed into our care, we require consent and acknowledgment of your pet's boarding.

Flea Treatment ($17-$18): For the health and safety of all of our hospitalized pets, all pets housed at our facility must be free of fleas. If fleas or evidence of fleas are found on your pet, an oral rapid-acting flea treatment will be administered (Capstar) at the owner's cost without the need for approval. *

I agree and understand

Injectable Sedation Consent (if needed): *

I am the owner or the agent for the owner of the animal described above, and I have the authority to execute this consent.
The nature of the procedure and the potential risks have been explained to me and I understand the procedure(s) to be performed. I understand that some risks always exist with sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any and all my questions have been answered to my satisfaction.
I hereby authorize ABC Veterinary Hospital Pacific Beach to administer sedation for my pet. Although rare, unexpected complications with sedation can occur. I understand the risks and understand that the veterinarians and hospital team will do everything possible to minimize any risks. Notwithstanding the risk, I waive any and all claims of damage against ABC Veterinary Hospital Pacific beach, its officers and employees, in the event of injury or death of my animal.

Cardiopulmonary Resuscitation (CPR) Directive

I understand ABC Veterinary Hospital Pacific Beach requires a CPR status when my pet is left in their care. I acknowledge that the attending veterinarian or staff members of ABC PB will make every effort to contact me regarding treatment in the case of this unforeseen event. The initial cost of CPR, Oxygen and Emergency Injections start at approximately $650.

CPR means “Cardio Pulmonary Resuscitation” and is the treatment (resuscitation) of a pet who has stopped breathing or whose heart has stopped beating. Resuscitation of a pet who has stopped breathing but still has a heartbeat is more likely to succeed than resuscitation of a pet with no heartbeat. DNR means “Do Not Resuscitate.” This means that if a pet stops breathing or his/her heart stops, no effort will be made to attempt to revive the pet, and the pet will die.

I am the owner / agent of this pet and ... *

I AUTHORIZE CPR and Emergency Efforts for my pet
I DO NOT AUTHORIZE CPR and Emergency Efforts (DNR) for my pet

Date of Acknowledgment: *

I understand that full payment for services is due at time of services. I understand that as the owner or agent, I am financially responsible for all charges relating to this patient. I have read and agreed to this treatment authorization and have agreed to the financial obligations.  *

Clear Signature

ABC Veterinary HospitalSpecialty Ultrasound Booking Consent Form

The phone number(s) where you can be reached today:

Section Divider

Book an appointment!

questions?Get in Touch

Our Location

Our Contact Information

Our Hours