Emergency Patient Transportation

Emergency Patient Transportation Authorization & Consent

Owner and Patient Information

Owner's Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Country Phone Number

Pet's Name(Required)

Date(Required)

Authorization for Emergency Transportation

Your veterinarian has recommended that your pet be transferred to another veterinary hospital for continued care, monitoring, treatment, and/or hospitalization. When professional veterinary transportation is recommended, Animal Eye Care (AEC) utilizes Veterinary Emergency Transportation Services (V.E.T.S.), a third-party veterinary transportation provider.

I confirm that I am the owner of the above-named pet or am authorized by the owner to make medical and financial decisions on the owner's behalf. *(Required)

Please Sign or Initial

I understand that my veterinarian has recommended transfer of my pet to another veterinary facility for continued care, monitoring, treatment, and/or hospitalization. *(Required)

Please Sign or Initial

I authorize Animal Eye Care to arrange transportation of my pet with Veterinary Emergency Transportation Services (V.E.T.S.) on my behalf. *(Required)

Please Sign or Initial

Transportation Fee Authorization

I understand that I am financially responsible for all costs and fees incurred in connection with the transportation of my pet, including any additional charges that may result from my pet's condition, level of monitoring, medical support, transportation distance, or other services required during transport. *(Required)

Please Sign or Initial

I understand that transportation costs are separate from charges for medical care provided by Animal Eye Care and/or the receiving veterinary hospital. I understand that I am responsible for all applicable transportation charges regardless of my pet's medical outcome. *(Required)

Please Sign or Initial

Risks Associated With Transportation

I understand that my pet is being transferred because additional veterinary care, monitoring, treatment, and/or hospitalization has been recommended. Transportation of a sick, injured, anesthetized, sedated, or otherwise medically compromised patient involves inherent risks. A patient's medical condition may change or deteriorate during transportation despite appropriate monitoring and supportive care.

I understand that my pet's condition may change or worsen during transportation and that complications may occur, including cardiopulmonary arrest or death. *(Required)

Please Sign or Initial

CPR / Emergency Instructions During Transportation

In the event that my pet experiences cardiopulmonary arrest during transportation, my wishes are:(Required)

Attempt CPR

Do Not Resuscitate (DNR)

I understand that emergency care capabilities during transportation may be different from those available in a veterinary hospital and that successful resuscitation cannot be guaranteed. *(Required)

Please Sign or Initial

Third-Party Transportation Acknowledgment

I understand that Veterinary Emergency Transportation Services (V.E.T.S.) is a third-party transportation provider and is not an employee of Animal Eye Care. I authorize Animal Eye Care to coordinate my pet's transportation with V.E.T.S. on my behalf. *(Required)

Please Sign or Initial

Emergency Contact During Transportation

Primary Phone Number(Required)

Country Phone Number

Secondary Phone Number(Required)

Country Phone Number

If I cannot be reached during transportation, I authorize Animal Eye Care, V.E.T.S., and the receiving veterinary hospital to communicate regarding my pet's condition and transportation needs in an effort to facilitate timely veterinary care. *(Required)

Please Sign or Initial

Final Authorization

I acknowledge that I have had the opportunity to ask questions regarding my pet's recommended transfer, transportation arrangements, associated transportation fees, and the potential risks of transportation. I have read and understood the information above. I authorize Animal Eye Care to arrange transportation of my pet through Veterinary Emergency Transportation Services (V.E.T.S.) and authorize the transfer of my pet to the receiving veterinary hospital identified above. *(Required)

Please Sign

Name(Required)

First Last

Today's Date(Required)

Time(Required)