Medical Authorization and Financial Agreement

  • You have been provided with a medical care plan which includes an estimate of costs based on anticipated care, diagnostics, and procedures, if relevant. Please note that this estimate is based on the information available to the doctor at the time the plan was created and reflects the care that you have approved. We are committed to providing your pet with the best possible care. Because your pet’s condition and medical needs may change, we sometimes must run tests or provide treatment that we did not anticipate when creating the medical care plan. We will do our very best to inform you of changes in your pet’s condition and the associated plan and will seek your permission for additional services that may cause an increase in the approved financial estimate. If we are unable to reach you and/or when medical necessity requires immediate action by our doctors and veterinary staff, we will do our very best to provide needed care and treatment while limiting costs until we can reach you. By initialing below, you acknowledge that you accept responsibility for the cost of medical care in these situations.
  • Payment Policy

  • We accept cash, personal checks, Mastercard, Visa, Discover, American Express, and Carecredit for payment of services. We are not authorized under law to extend hospital credit or loans to clients. For this reason, payment is due at the time services are rendered. Receipt of payment in full on the balance of your account will be necessary at the time of discharge.
  • Pre-Payment Policy

  • We require a minimum deposit of a portion of estimated costs of your pet's treatment. If your pet is hospitalized with us, we will update you at least once daily on his or her medical condition, progress and any recommended changes to the medical care plan. Any changes in expected costs will also be discussed with you at this time and may necessitate additional deposit payments.
  • I fully understand the terms of this agreement and authorize the hospital staff to perform the services as discussed with the doctor and reflected on the medical care plan for my pet and associated estimate of costs. It is also agreed that if I do not pay this account as agreed that past due accounts are subject to costs of collection, including attorney's fees. I am the owner or authorized agent of the owner of the pet presented for care.
  • Personal Belongings

  • For patient safety and to protect your property, we ask that you retain your pet’s personal belongings. We will provide your pet with comfortable bedding and blankets. Please keep bedding, toys, leashes, harnesses, etc. at home for safekeeping.
  • Understanding of Risks & Authorization for Diagnosis & Treatment:

  • Even in the most controlled hospital environment new problems may be found and/or complications may arise during the process of carrying out diagnosis and treatment. Complications include negative or normal diagnostic tests, failure of the intended procedure, requirement of additional procedures or tests and/or life-threatening complications including death. In a hospital setting, the risk of infection is higher than in an ordinary environment. As the owner or authorized agent of the admitted pet, I authorize this hospital to administer such treatment as is necessary, and to perform the surgical, diagnostic and therapeutic procedures that are considered necessary. I also consent to the administration of anesthetics and sedatives as necessary for patient and personnel safety.
  • Understanding of Risks & Authorization for Diagnosis & Treatment:

  • Even in the most controlled hospital environment new problems may be found and/or complications may arise during the process of carrying out diagnosis and treatment. Complications include negative or normal diagnostic tests, failure of the intended procedure, requirement of additional procedures or tests and/or life-threatening complications including death. In a hospital setting, the risk of infection is higher than in an ordinary environment. As the owner or authorized agent of the admitted pet, I authorize this hospital to administer such treatment as is necessary, and to perform the surgical, diagnostic and therapeutic procedures that are considered necessary. I also consent to the administration of anesthetics and sedatives as necessary for patient and personnel safety.
  • Cardiopulmonary Resuscitation (CPR)

  • I authorize this hospital to perform cardiopulmonary resuscitation (commonly known as CPR) if deemed necessary by the hospital, during the entire duration of the current hospital stay. I understand that performing CPR will accrue additional costs (starting at $500-700+) and these are not represented on the provided estimate.
  • I hereby acknowledge that I have read the above, and that the risks of recommended treatments, procedures, anesthetics and surgeries, as well as alternatives (including no treatment), have been fully explained to and understood by me. I also certify that no guarantee or assurance has been made to me as to the results that may be obtained.
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