CPR Consent Form

Please fill out this form ahead of your visit to allow us to perform CPR on your pet in case of an emergency.

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CPR Consent Form

Contact Name *

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Pet Name *

CPR means “Cardiopulmonary Resuscitation” and is the treatment (resuscitation) of a pet who has stopped breathing or whose heart has stopped beating. Resuscitation of a pet who has stopped breathing but still has a heartbeat is more likely to succeed than resuscitation of a pet with no heartbeat. DNR means “Do Not Resuscitate.” This means that if a pet stops breathing or his/her heart stops, no effort will be made to attempt to revive the pet. If an event arises that requires CPR for your pet, every attempt will be made to contact you immediately. If the hospital staff is unable to reach you within 15 minutes after the initiation of CPR procedures, and after exercising reasonable medical judgement, CPR may not be continued if there appears to be no response to CPR and no evidence that continuing CPR will be beneficial in resuscitating your pet. While our best efforts will be made to resuscitate your pet, resuscitation may not result in a full return to normal mental and physical health. If your pet has been admitted to our facility for medical care, in the event of an unforeseen circumstances should your pet require cardiopulmonary resuscitation (CPR) including cardiac compression, positive pressure ventilation, emergency drugs and/or other intervention, you requested that the doctor(s) at the facility pursue such medical care as indicated below:

I request the staff of Stoneside Veterinary Hospital to perform CPR (Resuscitation) on my pet if my pet suffers respiratory or cardiac arrest. Costs of these services can be between $100-$300
I DO NOT want CPR performed on my pet

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CPR Consent Form

CPR Consent Form

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