I understand that the pet mentioned below is suffering from an incurable disease or injury. I have been informed that the treatment being rendered at this veterinary practice is simply prolonging my pet's life for a few days to a few months. I understand that the doctors of this facility recommend that no further surgery or treatment be performed.

Their concern is that my pet is unlikely to heal or recover from such efforts, that additional medication would likely make my pet sicker, that my pet is starving to death, and/or that the cancer, disease, and/or complications associated with the underlying illness may recur within a matter of days or weeks.

In spite of the fact that the prognosis for my pet is poor, I am requesting that the doctors and staff at this facility proceed with surgery and/or all medical care that can be provided. In view of the poor prognosis, I understand that I will be required to pay in advance for all further veterinary services.

lf I decide to proceed with surgery, medical procedures, and/or further pain management, radiation, antibiotic, antifungal, fluid, chemo or immunotherapeutic agents, I will be expected to make satisfactory arrangements and agree to pay for all outstanding veterinary fees estimated below* to cover the anticipated fees for such care and possible complications prior to a) the admission of my pet to this hospital or b) the provision of further care while he/she is hospitalized at this facility.

In the event I am unwilling or unable to comply with these requirements, I understand that the attending doctors and staff will be unable to provide further medical services. I understand that they are, however, willing to refer my pet and me to another veterinary hospital, provide terminal pain managed hospice care or humanely euthanize him/her at any time at my request.

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