OPEN 7 DAYS A WEEK, INCLUDING SATURDAYS & SUNDAYS

Emergency Care Authorization

Please fill out our Emergency Care Authorization & Deposit Form using one of the options to authorize emergency treatment at Veterinary Medical And Surgical Group–OC (VMSG-OC) in Orange County.

OPTION 1
Complete Online

Complete and submit the online form below.

OPTION 2
Print & Complete

Bring the completed form with you to our hospital.

Download Form

OPTION 3
Complete on Arrival

If you prefer, complete the form when you get to our hospital.

Emergency Care Authorization & Deposit Form

Please complete the following form.

Owner Information & Contact

Owner First Name *

Owner Last Name *

Email *

Primary Phone *

Secondary Phone

Emergency Care Authorization

The emergency doctor on duty will be working to stabilize your pet and provide you with information. The doctor may be relaying this information through the team. A written estimate for charges will be provided as soon as the doctor is able to create a treatment and diagnostic plan (estimate) for your pet’s visit.

We require authorization to perform emergency treatment. Emergency treatment charges vary. Your pet’s immediate care is started with an initial authorization deposit of $500.00 to $1000.00. These fees may include: Exam, IV catheter, fluids, emergency medications, X-Rays, CPR.

Do you authorize us to perform emergency treatment. *

Yes

VMSG-OC is a critical care facility, and as such, all patients must have an emergency authorization form when in our care. This authorization clarifies for us what your preference is in the event of a life and death emergency (such as cardiac arrest). We will always attempt contact with you during a crisis. Please indicate your orders for the care of your pet:

I authorize the following: *

DNR (Do Not Resuscitate) - Allow natural death, no resuscitation

CPR - Cardiopulmonary Resuscitation and medication intervention performed as prescribed by the Veterinarian

By submitting this form, I grant permission to VMSG-OC to render emergency care if needed at a time that I cannot be reached and if CPR is performed there will be additional costs. CPR is estimated to range between $300 - $700. By submitting this form, I also acknowledge that no guarantee can be given or will be implied as to the outcome of treatment. I understand that I am financially responsible for the authorization given here.

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Emergency Care Authorization

OPTION 1Complete Online

OPTION 2Print & Complete

OPTION 3Complete on Arrival

Emergency Care Authorization & Deposit Form

Owner Information & Contact

Emergency Care Authorization

New Patients Welcome

OPTION 1
Complete Online

OPTION 2
Print & Complete

OPTION 3
Complete on Arrival