Palliative/Hospice Care Consent Form

This form is for patients receiving palliative/hospice care. 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
Primary Phone #:*
Primary Email Address:*
Enter Email Confirm Email
Pet's Name:*
Consent for Treatment:*
I agree and consent to treatment
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 the purpose of my pet's veterinary care moving forward is to maintain and/or improve quality of life. I further understand that during the course of treatments, 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 treatment is initiated. I have been informed that there are risks associated with the use of any medication/treatment. 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.

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

P.O. Box 89
Bel Air, MD 21014

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