Internal Medicine Registration Form

  • Date and Time of Scheduled Appointment

  • MM slash DD slash YYYY
  • :
  • Patient Information

  • Authorization for Services

  • By signing below, I certify that I have read and reviewed the above policies and that I have received and reviewed the procedures and policies handout for the internal medicine services.
  • Has your pet had any of the following signs?

  • Cardiopulmonary Resuscitation Status Election Form

  • ln the event your pet experiences a respiratory or cardiac arrest while in our care, cardiopulmonary resuscitation (CPR) can be administered based on the medical judgement of the veterinarians at Pet Emergency Clinic & Referral Center. CPR includes but is not limited to chest compressions, insertion of a breathing tube with manual ventilation, and administration of emergency drugs. The success of CPR depends on how advanced your pet's condition is.