ALL CREATURES VETERINARY CLINIC
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INFORMED CONSENT FOR VETERINARY MEDICAL PRODUCTS AND PROCEDURES
By asking you to read and sign this important notice All Creatures Veterinary Clinic (ACVC) is fulfilling its obligation to certify ACVC has informed you about risks and benefits of procedures ACVC recommends, sells, or dispenses. Please read this carefully. We encourage you to ask any questions about your pet’s health and safety while under the care of the staff at All Creatures Veterinary Clinic.
I understand I am under no obligation to obtain services or products at ACVC. I understand that there are a number of other local veterinary care facilities at which I can obtain veterinary services and products, after hour emergency services, and veterinary specialists services.
I understand any time a medication, vaccine, flea/tick preventative or other topical or oral medication is administered there is a very slight risk the pet could have an adverse reaction to the product. I will immediately report any severe adverse or unexpected reaction in my pet to ACVC.
I understand some procedures such as surgery, radiography (“taking x-rays”), or restraint for minor procedures may require the use of tranquilizers, sedation, light general or deeper anesthesia. I have been informed there can be unexpected adverse events resulting from these drugs. Adverse events can range from subtle or mild to extensive and life-threatening. For example, I understand any sedation or anesthetic agent could create abnormal heart rhythms, rapid changes in blood pressure or unexpected suppression of respiration. I understand in each unique administration of any drug ACVC takes due diligence visually and/or via instrument monitoring of the patient and has ready access to emergency medications and fluids that may be needed to counteract an adverse event.
I understand that I must do my part in following the doctor’s medical and post-operative directions.
I understand I should contact ACVC as soon as reasonable if I have questions about my pet’s medications, post-operative care, anticipated recovery times, or other issues resulting from my pet’s health care at ACVC. I understand that anesthetic and surgical, diagnostic or therapeutic procedures may involve risk of complications, injury, or even death, from both known and unknown causes and
no warranty or guarantee can be made as to result or cure
. Furthermore, I authorize the hospital staff in an emergency situation, to follow through with such procedures as are necessary for the well-being of my pet on a continuing basis until further communication occurs with me. I agree to assume financial responsibility for all routine and emergency services rendered by ACVC.
Because each patient is unique and no two surgical or medical interactions are identical I understand estimates for medical and surgical services are
estimates
or
ranges
for costs incurred. I understand fees incurred for my requested services need to be paid at the time service is rendered unless prior alternative arrangements are made. My signature below acknowledges that (1.) I have read and agreed with the above. (2.) The procedure(s) have been explained to my satisfaction and (3.) I have had the chance to ask questions, and (4.) I authorize and consent to the performance of my requested procedure(s) and the administration of anesthesia and (5.) I have been offered elective baseline or diagnostic lab tests and have either accepted or declined. (6.) I also understand that due to age, chronic medical condition or acute illness some diagnostics may be
required
prior to any procedure involving sedation or general anesthesia and fluid therapy may need to be administered during the procedure.
NOTES: __________________________________________________________________________
Signed by pet owner: _______________________________ Date:__________________________
Signed by ACVC staff member: _______________________ Date:__________________________