Sedation Form Name*Phone*Email* Sedation ConsentDo we have permission to sedate your animal today, if necessary?* Yes No CPR/DNRIn the event that your pet should experience cardiac or respiratory arrest while boarding, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of your pet's status?By consenting to this service, you are also acknowledging that certain charges will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion. I agree to CPR being performed in case of arrest and agree to any financial obligations as a result of CPR being performed regardless of outcome. I elect a “Do Not Resuscitate” status in case of arrest. Please select one of the following options:* I wish to be contacted with a treatment plan after an examination is completed and before any additional treatment not previously discussed is performed. I understand that if I cannot be reached in order to discuss additional treatment, any further procedures may need to be rescheduled for a future date based on time constraints. I pre-approve treatment as the veterinarian deems necessary, up to $(please mention in below box). I understand that the veterinary staff will contact me for further consent if the recommended treatment will go over this pre-approved dollar amount. Up to $*PHONE NUMBER(S) WHERE YOU CAN BE REACHED TODAY*If you cannot be reached at the phone number provided above, we will not proceed with the procedure or treatment. This can cause delays in pick-up times, and our ability to treat your pet. You will be still be charged for any services performed.OWNER RELEASE AND CONSENTMVVH Orland, Inc., doing business as Mid-Valley Veterinary Hospital, will use all reasonable precautions against injury, escape, or death of your pet. I understand that sedation always involves some risk to your pet and agree to hold Mid-Valley Veterinary Hospital harmless, in the absence of negligence, in connection with these procedures. I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. In the event complications arise and I cannot be immediately contacted at the below listed phone number, Mid-Valley Veterinary Hospital is directed to make the decision(s) it deems best for my pet. I have read the foregoing, understand what it says, and agree. I ACKNOWLEDGE THAT PAYMENT IS DUE AT TIME OF DISCHARGESignature*Date MM slash DD slash YYYY
