Procedure Consent Form PDF Procedure Consent Form Resuscitation Agreement(Required) I authorize the attending veterinarian and the staff of Bush Advanced Veterinary Imaging to administer all necessary treatments, including CPR (cardiopulmonary resuscitation) if needed. I also understand that the severity of the complications may warrant transfer to our on-site emergency department for more intensive care and I authorize the attending veterinarian to refer the animal listed below to our emergency department. Cost for CPR alone could add $300-$500 to the fees I have already been provided. Additional charges that are incurred for further treatment would be discussed with you by our on-site emergency department. I do not want the animal listed below to be resuscitated in the event of cardiac or respiratory arrest. No life saving measures should be taken. Read Confirmation(Required)I acknowledge that no guarantees have been made except reasonable precautions against injury, escape, or illness with the understanding that I will remain fully responsible for the cost of all services provided by Bush Advanced Veterinary Imaging and its authorized agents. I have read and understand this authorization and consent LocationLeesburgRockvilleSpringfieldClient Name(Required) Prefix Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Name Last Name Name of Animal(Required) Date(Required) MM slash DD slash YYYY Emergency Number(Required)CAPTCHA
