206-523-7187

info@northseattlevet.com

Urgent Care
Consent Form

Please fill out this form as completely as possible so we can get to know you and your pet(s). Thank you!

Get Started

Pet Details

Pet Name(Required)
Sex(Required)
MM slash DD slash YYYY

Owner Details

Name(Required)
May we text you if we cannot reach you by phone? *(Required)
Address
Does your pet do/visit any of the following(Required)
Where does your pet spend their time?(Required)
Do you have other pets in the household?(Required)
Any recent changes in water consumption?(Required)
Any recent changes in urination?(Required)
Any recent changes in appetite?(Required)
Any recent changes in energy or mobility?(Required)
Any recent changes in your pet's stools?(Required)
Any recent vomiting?(Required)
Any recent coughing?(Required)
Any recent sneezing or congestion?(Required)
Please add on the following services today, if health permits

Emergency Life-Saving Measures

In the rare event that cardiac arrest occurs, would you like us to perform CPR? All attempts will be made to reach you, but knowing ahead of time will allow us to act as quickly as possible. Emergency CPR treatment will have an additional cost.(Required)

Authorization For Services

Previous Veterinary Care

Would you like us to send today's records to this other veterinary clinic?(Required)
I authorize North Seattle Veterinary Clinic to examine and initiate care and treatment for my pet. This may include treatment for shock and pain. I understand that no guarantee or warranty for success can be given and that some risks are involved in all procedures and treatments. I assume financial responsibility for charges incurred to this patient. If I am not the owner of the animal, I represent that I have been given authority by the owner to obtain medical treatment for this patient, and to incur costs of its care. I understand payment in full is due at the time I pick up the patient.