Treatment ConsentForm

Thank you for choosing Los Gatos Dog & Cat Hospital for your pet’s care. To help us provide the best care for you and your pet, please complete our online treatment consent form.

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Treatment Consent Form

Please fill out this form as completely and accurately as possible to help us get to know you and your pet(s).

Owner Name *

First

Last

Pet Name *

Species *

Breed *

Sex *

Email *

I, the undersigned owner, authorized agent of the owner, or Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am: Eighteen (18) years of age or older. I authorize and consent to the examination, diagnostics, treatment, and care of the above-named pet by the veterinarians and staff of Los Gatos Dog & Cat Hospital. *

I agree

Please read and initial each statement below

1. Financial Estimates & Fees *

I understand that an estimate for recommended services and treatments is available upon request. I acknowledge that I may discuss fees and treatment plans with the veterinary team before services are performed and throughout my pet’s ongoing medical care.

2. Payment Responsibility & Discharge *

I agree that I, or an authorized representative, will pick up my pet at the time of discharge and assume full financial responsibility for all charges incurred during treatment. Payment is due in full at the time services are rendered or upon discharge.

3. Authorization for Treatment *

I authorize the veterinarians and staff at Los Gatos Dog & Cat Hospital to administer medications, perform diagnostic testing, provide hospitalization, sedation, anesthesia, and/or surgical procedures as deemed medically necessary for my pet’s care. I understand that anesthesia and surgical procedures carry inherent risks, and I have been encouraged to discuss any questions or concerns with the attending veterinarian prior to treatment.

4. Risks & No Guarantee of Outcome *

I understand that all medical and surgical procedures involve some level of risk, including complications, unforeseen reactions, or death. I acknowledge that no guarantee or warranty has been made regarding the outcome, recovery, or cure of my pet’s condition.

5. Appointment Recording Consent *

I understand that portions of my appointment and medical discussions may be audio recorded for the purpose of improving and streamlining electronic medical record documentation. By initialing, I consent to this recording process.

CPR / DNR AUTHORIZATION

While serious complications related to sedation or anesthesia are rare, unexpected emergencies including cardiac and/or respiratory arrest can occur. In the event of an emergency, please indicate your wishes below regarding cardiopulmonary resuscitation (CPR). *

YES — Perform CPR (I authorize the veterinary team to perform CPR and emergency life-saving measures if deemed necessary. I understand additional fees may apply and that successful resuscitation cannot be guaranteed.)
NO — Do Not Perform CPR (DNR) - (I do not authorize CPR or emergency resuscitation efforts in the event my pet experiences cardiac or respiratory arrest.)

Owner/Authorized Agent Signature *

Clear Signature

Date *

Phone Number *

Phone

Treatment ConsentForm

Treatment Consent Form

Please read and initial each statement below

CPR / DNR AUTHORIZATION

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