Hospital Consent Form | Rockwall Urgent Vet

Name*

First Last

Email*

Phone*

Pet Name*

I am the owner of this pet and hereby authorize Rockwall Urgent Vet to perform agreed upon procedures, testing and treatment plans*

This may include appropriate anesthesia, surgery & hospital care treatments.

Yes
No

The nature of the testing, treatment plans and procedures has been explained to me, and I understand what will be done.*

Please refer to estimate provided for costs associated with recommended treatment.

Yes
No

I have been informed that there are certain risks and complications associated with any surgical operation, procedure or treatment plan. I understand that during the course of treatment, unforeseen conditions may arise that will necessitate the performance of additional procedures. I further realize and understand that medical and surgical treatment outcomes are not guaranteed.*

Yes
No

In the event that my pet should experience cardiac arrest, I elect:*

CPR - I authorize resuscitative efforts to be performed on my pet.
DNR - I decline resuscitative efforts to be performed on my pet.

Signature*

Phone

This field is for validation purposes and should be left unchanged.