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Admittance Sheet

Welcome to our Point Grey Veterinary Hospital. If you have any questions during or after your visit, please don’t hesitate to let one of us know. We strive to provide outstanding service to you and exceptional care for your pet.

Admittance Sheet

Please submit prior to your pet’s scheduled appointment to ensure all your details are correct in our system. Forms must be submitted in English.

MM slash DD slash YYYY
Name(Required)
Address(Required)
Authorization(Required)

Pet Information

They have urinated this morning?(Required)
They have defecated this morning?(Required)

Contact Information

Please provide us with all contact numbers where you can be reached during the procedure.
In the event that I am not available to provide further instructions hereafter, I give permission to the staff to discuss further financial and medical aspects of this case on the same basis as above with the following:
Name

Treatment Consent

Consent(Required)

CPR Consent

CPR consent - By signing this, you choose to consent or not consent to Point Grey Veterinary Hospital performing CPR on your pet. Cardiopulmonary resuscitation, or CPR, is the emergency treatment used for cardiac and/or respiratory arrest. This means that a patient's heart has stopped beating and/or the patient has stopped breathing. DNR means “do not resuscitate”. This is a decision that resuscitation (CPR) is not to be performed.
I understand Point Grey Veterinary Hospital requires a CPR status prior to admittance of all patients so immediate action can take place in the event of cardiac or respiratory arrest. The cost of performing CPR may be up to $300. I understand that by agreeing to have CPR performed on my pet, I am responsible for paying the fees associated with this. I understand that despite the best efforts of the medical team, CPR may not be successful. If the veterinary staff, after exercising reasonable medical judgment, determines that CPR will not have a successful outcome, they will cease further CPR procedures.(Required)
MM slash DD slash YYYY
Please type your name below(Required)
This field is for validation purposes and should be left unchanged.
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