Newest Form Page Client InformationClient Name Address Street Address City State / Province / Region ZIP / Postal Code Phone Patient InformationPatient Name Species Breed Sex Color Weight Is your pet spayed/neutered? Yes Date MM slash DD slash YYYY Start with the bracketed "p" Use the bracketed "br/" for two line breaks List items "ol" means ordered list "ul" means unordered list List Item 1 List Item 2 List Item 3 "strong" will bold words "u" will underline words Last information listed and end with a "/p" tag!Cardiopulmonary Resuscitation (CPR) DirectiveI understand Veterinary Specialists of the Rockies (VSR) requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of VSR will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400.I am the owner / agent of this pet and I ... DO AUTHORIZE CPR efforts for my pet DO NOT AUTHORIZE CPR (DNR) efforts at this time Signature SectionOwner/Agent Signature(Required)PhoneThis field is for validation purposes and should be left unchanged. Δ
