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I am the owner, authorized agent for the owner, or a Good Samaritan responsible for seeking veterinary care for 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 potential complications associated with sedation, anesthesia and/or any operation/procedure/treatment/medication that may result in injury, harm or even death from both known and unknown causes. These risks and potential complications have been explained to me to my satisfaction. I further understand that during the course of the operation(s) or procedure(s), unforeseen conditions may arise that may require the performance of additional urgent care services deemed necessary by the attending 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/sedation, hospitalization, diagnostic testing, patient monitoring, treatments and medications as needed before, during or after the procedure.
I understand that a treatment plan providing the details and costs for the anticipated veterinary services will be provided to me, at my request, and that I am encouraged to discuss all fees attendant to such care before services are rendered and during my pet’s ongoing medical treatment. In the event that hospitalization is required for more than twenty-four hours for ongoing care, I agree to pay a deposit of 50% of the estimated fees and assume financial responsibility for the balance of all services rendered on a cash, credit card or check basis at the time the pet is discharged from the hospital or the case is otherwise concluded. I understand it is my responsibility to call the hospital at least every twenty-four hours during the duration of hospitalization to inquire as to the medical status of my pet and the fees incurred for medical services up to that day. I understand that veterinary care during nighttime hours and/or weekends is provided at the discretion of the attending veterinarian, and that if required, additional charges may apply. Continuous presence of personnel may not be provided during these hours.
I further agree, that either I, or an authorized agent of mine will promptly pick-up and pay for all accrued charges when I have been notified that my pet is ready to be released from the hospital. I agree that if I fail to comply with this policy within five days of oral or written notification of the readiness to be released, that Companion Animal Hospital may handle this abandonment in the best interests of the pet and/or the hospital in accordance with the local laws and I will still be responsible for all fees incurred.
The nature of these operation(s) and/or procedure(s) has been explained to me to my satisfaction and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and I understand that no warranty or guarantee has been either expressed or implied as to a cure or a specific result. 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.
917 S. Rand Rd.,Lake Zurich, IL 60047
9:00am - 6:00pm
9:00am - 3:00pm
8:00am - 2:00pm