Advanced Directive Form CALL NOW Please complete this form before your visit. Please enable JavaScript in your browser to complete this form.Owner's Name *FirstLastEmail *Pet's Name *Diagnoses (if known) *We understand these questions may be difficult, but your answers are essential to ensure that we provide the best care to each patient in the event of an emergency while meeting the expectations of our clients. Please do not hesitate to ask if you have any questions or would like to speak to a member of our team about the treatment that may be provided. Emergency and stabilization care can cost $500 or more. This is only for the initial stabilization of your pet. Further treatment and diagnostics will likely be necessary and will accrue additional charges. If stabilization and/or resuscitation is successful, many patients will require extensive monitoring and care, and may never make a complete recovery.In the event of a life threatening illness or disease: *I hereby give complete and full authority for the doctor(s) and/or staff of Novey Animal Hospital to perform any diagnostics and procedures deemed necessary. This can include diagnostics and treatment, surgery, and transfer to a 24 hour facility for continued care.I DO NOT give complete and full authority for the doctor(s) and/or staff of Novey Animal Hospital to perform any diagnostics and procedures deemed necessary. This can include diagnostics and treatment, surgery, and transfer to a 24 hour facility for continued care.I understand that Novey Animal Hospital will make every reasonable effort to contact me, while my pet is stable. I understand that if I select “DO NOT” above and I am unreachable, that my pet may die due to the severity of its illness.If Novey Animal Hospital is unable to reach me at the contact information I have provided: *I hereby give complete and full authority for the doctor(s) of Novey Animal Hospital to humanely euthanize my pet, if deemed necessary to alleviate suffering.I DO NOT give complete and full authority for the doctor(s) of Novey Animal Hospital to humanely euthanize my pet, if deemed necessary to alleviate suffering.In the event my pet’s heart and/or breathing stop (cardiopulmonary arrest), I request the following resuscitation effort(s) be implemented (choose one): *DO NOT RESUSCITATE – In the event my pet’s heart and/or breathing stops, I request that no person shall attempt to resuscitate my pet by any means, including by administration of any medications.CARDIOPULMONARY RESUSCITATION – I request that the doctor(s) and staff attempt to resuscitate my pet through utilization of artificial respiration and/or heart compression and the administration of various emergency medications and/or fluids (CPR) as deemed necessary and/or appropriate by the attending veterinarian. I understand that recovery rates are low for CPR.I understand that the doctor(s) and/or staff of Novey Animal Hospital will begin resuscitation efforts as directed above and will immediately attempt to contact me via the provided contact information. If Novey Animal Hospital is unable to reach me at the contact information I have provided and my pet is deemed to be suffering and unstable: *I hereby give complete and full authority for the doctor(s) and staff of Novey Animal Hospital to humanely euthanize my pet, if deemed necessary to alleviate suffering.I DO NOT give complete and full authority for the doctor(s) and staff of Novey Animal Hospital to humanely euthanize my pet, if deemed necessary to alleviate suffering.Being of sound mind, I voluntarily authorize this directive for my pet listed above, and I understand its full import. If I decline to choose an option, then I understand that Novey Animal Hospital and its staff are ethically and legally obligated to provide stabilization care until I can be contacted and that I will be financially responsible for that care.Signature *Clear SignatureDate *Submit
