EWAH Procedure, Anesthesia & Medical Authorization Release Form
    ​I certify that I am the owner, or authorized agent for the owner, of the above animal. I  hereby consent to and authorize the doctors and staff at this veterinary practice to admit this pet, perform the above described procedures, and administer medications, anesthesia, surgical procedures, tests and or treatments that the doctors deem necessary for its health, safety and well being while under their care and supervision. I have been advised of the nature of the procedures and the potential risks and benefits. I understand that veterinary medicine is an inexact science and that no guarantee of successful treatment can be made. 

    I acknowledge that I am responsible for payment in full for the above procedures and treatments at the time my pet is discharged.
    ​
                                                 Consent for Cardiopulmonary Resuscitation (CPR)

    Should my pet require cardiopulmonary resuscitation (CPR), including cardiac compression, defibrillation, positive pressure respiration, emergency drugs, or other heroic interventions, I request that the doctor(s) at this hospital pursue such medical care as indicated below. Having requested such emergency procedures, I agree to be held responsible for a minimum resuscitation fee of $125.00 + medications to pay for the services performed while staff members pursue treatment and try to reach me for further directions. Regardless of my pet’s survival, I agree to pay this fee in addition to the other fees already identified by the practice and agreed upon by me.

    I request one of the following CPR services (please initial the appropriate choice):
         1.  Endotracheal intubation, positive pressure respiration, administration of emergency drugs, and/or external cardiac 
              massage ~$140.00 + medications. (CPR)
         2.  I elect not to have the staff pursue any CPR procedures for my pet and, instead, request that the attending doctor assist 
    ​          my pet in dying in a peaceful manner.  Do not resuscitate (DNR).
    ​I accept that if the hospital staff is unable to reach me within 15 - 30 minutes after the initiation of CPR procedures, and after exercising reasonable medical judgment, determine that there appears to be virtually no hope for medical success, they will cease further CPR procedures. I understand that despite the best efforts of the doctors and staff at this facility, even the most successful CPR that restores my pet’s life may not allow my pet to regain his/her normal mental and physical health and, thus, may leave him/her as an invalid.

                                                       Intravenous (IV) Catheter and Pain Medication
    Your pet will have an IV catheter placed to medications and fluid therapy during and after the procedure.  This will assist in hydration and recovery after being anesthetized and help to move the anesthesia out of the body.  It will also allow immediate treatment of possible anesthetic reaction or side effects.

    A pain injection WILL be given to your pet to reduce pain and discomfort.

                                                                               Laser Therapy
    MLS Therapy is a therapy for treating pain, inflammation, and edema as well as repairing superficial lesions.  Laser emissions have an immediate effect on pain and act fast on inflammation, stimulating blood and lymphatic circulation which induces reabsorption of fluids.  EWAH recommends at least 1 session, an optimum 3 sessions post procedure. 

                                                                Microchip
    Microchips are a safe, effective, and permanent way for rescuers to identify your pet in the event of an emergency.  The procedure is equivalent to an injection, using a larger needle to insert the microchip.  Our microchips will also take your pet's temperature!  No more rectal thermometer :).  It also includes lifetime registration.
                                                             Dental Procedures
    If your pet is here for a dental procedure the doctor has given them a preliminary dental grade that may include a certain number of extractions.  Dependent upon the results of the dental radiographs, there may be the need for additional extractions.  We are looking at what is in the best interest of your pet, we prefer not to extract, but it is sometimes necessary.
         1.  Yes, you may extract necessary teeth
         2.  No, I do not want any extractions performed on my pet
         3.  I understand my pet is not scheduled for a dental procedure; if the doctor determines there are unhealthy teeth that
              should be removed, I authorize those extraction only, understanding there is an additional cost.
         4.  My pet is not scheduled for any oral procedures.  If something is noted, please call the contact number listed above
                                           Soft Tissue / Growth Removal (Biopsy)
    If your pet is to have a mass removal, we often recommend submitting the sample to the laboratory for histopathology (identification).  We ask your permission to submit the sample to the lab.
                                                              AUTHORIZATION
    By completing and submitting this form, I authorize the veterinarian to examine, prescribe for, or treat my pet.  I assume all responsibility for charges incurred for the care of my pet. I also understand all charges will be paid at the time of discharge and a deposit may be required for surgical treatment.

    Please authorize this acknowledgement and the answers to the questions above by entering your full name below.