phone number directions directions
pet emergency
phone number directions directions
pet emergency

Authorization for Critical Care treatment

Client Information


Patient Information

Is your pet spayed/neutered?
MM slash DD slash YYYY
Your pet presents in critical condition. Please sign one of the two following agreements.

Cardiopulmonary Resuscitation (CPR) Directive

I 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 ...

The initial costs of Critical Care stabilization are estimated at $750. This estimate is for initial stabilization only and does not include continued care once your pet is stabilized nor, does this estimate include hospitalization, treatments, medications or follow-up care. These initial costs also do not guarantee a positive outcome. PAYMENT FOR EMERGENCY STABILIZATION IS REQUIRED UPON AUTHORIZATION.

The doctor will speak to you as soon as reasonably possible and will provide you with a written estimate of the total expected charges, including emergency treatment. Your payment for emergency treatment will be applied to the total costs. A deposit for the low end of the estimate will be required to continue treatment. WE DO NOT OFFER ANY PAYMENT PLANS, however third-party financing options may be available to you for more extensive care.

This field is for validation purposes and should be left unchanged.