Forms – Happier at Home Mobile Veterinary Hospital

Consent For Treatment Form

This form is for patients coming to us for procedures that require hospitalization and/or sedation. Please read everything carefully and hit "Submit" when complete. If you have any questions, please reach out to one of our staff members.
Today's Date:*
Date Format: MM slash DD slash YYYY
Owner's Name:*
First Last
Pet's Name:*
Date of Visit:*
Date Format: MM slash DD slash YYYY
Reason for Visit?:*
If "other", please specify:*
Primary Phone #:*
Alternate Phone #:
I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age. I have been informed that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated. I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication. The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.*
- I agree and consent to treament
Do you wish for your pet to be microchipped today?:*
- Yes
- No
- My pet is already microchipped
I have received an estimate for my pet's procedure and agree to pay the balance in full at the time if discharge.*
- Yes
- I have not received an estimate and request one prior to my pet's appointment
In the event that my pet should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of their status? By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion.*
- Yes, I agree to CPR being performed in the case of arrest
- No, I elect a DO NOT RESUSCITATE status in the case or arrest
By submitting this form, I agree that I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.
Please click the "Submit" button when the form is complete.

Contact Us

Reach out to us and we will be happy to answer any questions, discuss your pet’s health and book an appointment.

Mailing Address

P.O. Box 89
Bel Air, MD 21014

Contact

Phone: 443-966-4558
Email: info@happierathomevet.com

Hours

Monday – Friday:
9:00 am – 5:00 pm
Saturday:
Dental Procedures by appointment only
Sunday:
Closed

Consent For Treatment Form

By submitting this form, I agree that I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.

Contact Us

Mailing Address

Contact

Hours