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Consent Form

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Consent Form

Please fill out this form as completely and accurately as possible before your visit.

CPR in animals, like in humans, is a life-saving procedure that uses medications, artificial breathing and chest compressions. This is to help revive the pet when they stop breathing on their own and/or their heart stops beating.
I certify that I own/have assumed financial responsibility for the above-described animal. I do hereby consent and authorize the Touhy Animal Hospital and its staff to hospitalize this animal, and to administer vaccinations, medications, tests, surgical procedures, anesthetics or treatments that the doctors deem necessary for the health, safety, or well-being of the above animal while it is under their care and supervision. Veterinary services during nighttime hours, and/or weekends, are provided at the discretion of the veterinarian in charge. Continuous presence of personnel may not be provided during these hours. If the animal should injure itself in an escape attempt, refuse food, soil itself, become ill, or die while in the hospital, I will hold Touhy Animal Hospital free of any responsibility and/or liability in the absence of gross negligence. I further realize that I am responsible for the payment of the above procedures and treatments in full at the time the animal is discharged. If I neglect to pick up the animal within five (5) days of written notice, which is mailed to the above address, that the pet is ready for release, you may assume that the pet is abandoned. In cases of abandonment, I understand that Touhy Animal Hospital is authorized to dispose of the animal as they see fit. Abandonment does not release me of my obligation for the bill. Any surgeries or procedures cancelled less than 48 hrs will forfeit the $150.00 scheduling deposit.
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