Hospitalization Consent Form in Andover, MA

Name*
First Last
Email*
Patient Name*
Breed*
Color*
Age*
Sex*
- Male
- Female
Thank you for the opportunity to help you meet your pet's healthcare needs. As discussed, the estimated fee for medical care is $ ___ for ____ hrs/days. Once treatment has begun, changes in the healthcare plan may be required depending upon results of diagnostics or changes in your pet's condition. We will contact you if the cost of care is expected to exceed the amount listed above and discuss further treatment options.
Amount*
hrs/days*
Your Initials*
Amount paid today or Deposit (100% of estimate)
Andover Animal Hospital, Inc. requires payment in full or care credit at the end of the examination and/or at time of discharge.
Emergencies (Please Initial):
In case of emergency
- I hereby authorize treatment up to and including chest compressions, medications, and artificial respiration in the case of an unforeseen emergency. I understand that these interventions can be costly and outcome is not guaranteed. If the hospital staff is unable to reach me, and the doctors' medical judgment determines that there is no hope for success, I understand the staff will discontinue resuscitation.
- Do Not Resuscitate my pet (DNR). I wish to be notified prior to treatment of an unforeseen emergency. I understand that the delay in treatment could result in serious complications, including death.
Initial
Please initial: I understand that my pet is not supervised overnight*
If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.

By signing below, you agree to the foregoing terms of this agreement:
Signature*

What Our Clients Say

They take amazing care of my little Beanie and always send him birthday cards. It’s a nice touch! They’re the BEST

Phil B.

Had to bring my boy there for a emergency and the staff was so kind to me and my mother! The doctor was very welcoming and kind and he answered all my questions and definitely reassured me about my worries! Definitely will come here for my animals!

Katie N.

Andover Animal Hospital is one of the best vets I've ever been to. My cats and dog have received the best care here. They are truly run like a place that cares for pets and NOT like a business only out for profit. I am loyal for life!