Consent for Emergency Treatment

Get Started

Consent for Emergency Treatment

Printable Version

Name *

First

Last

Email *

Phone *

Cat's Name *

Initial examination indicates that your cat needs immediate medical attention. The cost for this initial care could range from $300 to $500 and typically includes an intravenous catheter, intravenous fluids, oxygen, heat, basic blood work, and pain medications. This estimate is for initial stabilization only and does not include continued care once your pet is stabilized, nor does this estimate include hospitalization, treatments, medications, or follow-up care.

The veterinarian will update you as soon as possible. At that time, we will provide you with a written estimate of expected charges for continued care. A deposit will be required for patients remaining in the hospital for continued care.

Please read and select one of the below: *

I give permission for immediate medical care and will be financially responsible for the incurred charges on the date of services. I understand that emergency treatment does not guarantee the survival of my cat. I understand that it is my obligation to pay in full for all services provided at the time services are rendered.
I do not authorize immediate treatment and want to speak to a doctor first. I understand that delaying necessary treatment could jeopardize the health of my pet. I release Atrium Cat Hospital and its doctors and staff from liability from any complications related to my choice to delay treatment.

Please read and select one of the below: In the event that my cat stops breathing or his/her heart stops beating, I request that the doctor and staff of Atrium Cat Hospital pursue such medical care as indicated below (choose ONE): *

I request that cardiopulmonary resuscitation (CPR) be performed in the event that my cat stops breathing or his heart stops beating.
I request that CPR NOT be performed in the event that my cat stops breathing or his heart stops beating. I understand that this will result in the death of my cat.

Signature *

Date *