Authorization for Emergency Treatment – Gladstone Veterinary Clinic

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Phone number where you can be reached today: *

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I consent to the emergency examination and stabilization treatment of this pet by staff veterinarians and their support team at Gladstone Veterinary Clinic. I agree to pay a deposit of $400 to begin emergency assessment and treatment. This may include the following, as appropriate, to help stabilize my pet:

Emergency Examination
Pulse Oxygenation Assessment
Blood Pressure
In-House PCV/Total Protein
IV Catheter Placement
Oxygen Therapy (up to 1 hour)
IV Fluid Therapy
Blood Glucose Level

CPR/DNR (select preference): In order to best carry out your wishes for this pet during our emergency assessment and treatment, please select your preference for CPR/DNR: *

Utilize all life-saving efforts, including CPR. Necessary life-saving procedures will be instituted at an additional cost.
Do not resuscitate

Once your pet has been stabilized and a plan for further treatment has been made, you may leave your pet for further diagnostics or treatment. Please do not leave GVC until you have spoken with a Veterinarian about your pet’s case and you have signed a treatment plan for additional care. *

I have read and understand.

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