Emergency Call-In Release & Deposit Form Emergency Call-In Release Form Name * Name First First Last Last Email * Phone * Patient Name * Species * Canine Feline Bird Small Mammal Reptile Amphibian Fish By checking the boxes below you acknowledge that you are asking Exotic Vet Care to provide Emergency Veterinary Call-In Services for your pet's emergency situation. You acknowledge that you are aware of Exotic Vet Care's service and financial policies and authorize Exotic Vet Care to retain the Non-Refundable portion of your Emergency Admission Deposit regardless of outcome, including if your pet does not survive transport to Exotic Vet Care, you decide to seek services elsewhere, or you are unable to make the trip to Exotic Vet Care for any reason. You acknowledge and understand that this initial deposit may not be sufficient to provide all the services your pet requires, and a further deposit may be necessary after examination of your pet and assessment of its condition. You grant permission for Exotic Vet Care to perform any immediately necessary lifesaving and supportive care and fully acknowledge and accept the costs and risks associated with emergency treatment and procedure(s). * I, the undersigned owner or agent of the pet identified above, agree to pay the $800-$2000 Call-In Emergency Deposit online, prior to my arrival, by clicking the link provided below. * I agree https://secure.usaepay.com/pay/1nkt6jxcngvtrbhn8/6vArjI63 I, the undersigned owner or agent of the pet identified above, authorize the staff of Exotic Vet Care to retain the $400 Non-Refundable portion of my deposit, regardless of outcome (including if my pet does not survive the trip to Exotic Vet Care, if I choose to seek services elsewhere, or if I am unable to make the trip to Exotic Vet Care for any reason). * I authorize I understand that this deposit may not be sufficient to provide all of the services and care my pet needs, and will provide further deposit as needed to continue my pet's care once assessed by the doctor. * I understand I understand that my pet is in critical condition and acknowledge that while all procedures will be performed to the best of the abilities of the staff at Exotic Vet Care, no guarantee or warranty has been made regarding the results that may be achieved. * I understand I assume full responsibility for any additional expenses incurred after the initial examination of my pet. * I understand I have read, fully understand, and will abide by the terms and conditions set forth. * I understand In the devastating event that your pet were to decline and experience a cardiac or respiratory arrest, our standard procedure would be to initiate CPR. Please note that costs of this can range from $200-400 per 15 minute session depending on nature and duration of intervention. Under certain circumstances the veterinarian may recommend that resuscitation not be performed; as a pet owner you may prefer not to have resuscitation performed. In such cases you have the option to elect a Do Not Resuscitate (DNR) order. Please note that recovery rates after CPR under anesthesia are better than rates after CPR due to illness or trauma. * Yes, I do wish to have CPR performed No, thank you. If my pet passes away please do NOT resuscitate him/her Please click the link to securely pay the required $800-$2000 Call-In Emergency Deposit. Online deposit must be paid in advance. https://secure.usaepay.com/pay/1nkt6jxcngvtrbhn8/6vArjI63 Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
