Critical Pet Form
Purrfect Pet Services
(425) 466-6386
Welcome to joining the family of Purrfect Pet Services, where we are comprised of only
individuals who have a minimum of 5 years experience as a veterinary technician. We look
forward to getting to know you and your extended family of pet(s). How comforting is it to
know you can leave your loved ones in the hands of someone else while you are away in the
luxury and warmth of your own home? You need someone that you can trust without a doubt.
We are excited to offer our services to your pet(s) with the compassion, care and vast
knowledge of veterinary medicine specializing in critical care and emergency medicine. Since
before we could even remember animals have always been a deep passion and we look
forward to extending our love to you and your family.
In case of an emergency Purrfect Pet Services reserves the right to take your pet into an
emergency clinic of our choice. Once indicated, Purrfect Pet Services will immediately
contact you and or your emergency contact if you are unable to be reached. With or without
contact we will seek immediate medical care. You have authorized us up to $_____________
for the credit authorization on file further diagnostics and treatment may require additional
cost. An alternate emergency contact would be other than yourself.
1) contact number: _________________ relationship: _________________
2) contact number: _________________relationship: _________________
3) contact number: _________________relationship: _________________
CPR Code:
In the event of a respiratory or cardiac arrest episode, I authorize the doctors and staff of
Access and Purrfect Pet Services to perform the following Cardiopulmonary Resuscitation
(CPR) efforts (check and initial):
__ DNR ( Do not Resuscitate): I understand that no efforts will be made to resuscitate my
pet.
___ Basic CPR: This includes ventilation support and closed chest compressions along
with required diagnostics, monitoring and medications. And additional cost of $400-800 is
authorized on top of any previously discussed estimate.
___ Advanced CPR: This includes Basic CPR plus any more-advanced treatments such
as open-chest CPR, advanced life support and diagnostics as deemed necessary by the
doctor(s). An additional Cost of $800-$1200 is authorized on top of any previously
discussed estimate.
Client Signature: ________________________
Client Name (printed): ________________________
Staff Signature: ________________________
Staff Name (printed): ________________________
Date: ________________________