Animal Center for Emergency and Specialty logo
Contact Us

NOW OPEN!

Forms

CPR Authorization Form

Save time at your first appointment! Complete your required CPR authorization form online before your visit.
Get Started

CPR Authorization Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

CPR Authorization

All pets that enter our doors require CPR authorization (or DNR election). This is regardless of the reason for their visit, as it is hard to know how sick a pet is on arrival. We value your wishes and understand that not every pet parent would want CPR for their pet. This form allows us to understand your wishes and to act quickly in the event of an emergency.

If you do not fill out this form, we will perform CPR if needed.

The reason for an arrest event is highly related to CPR success. If your pet arrests due to a medication reaction or sedation/anesthesia, for example, CPR is often more successful than if your pet arrests due to a severe or chronic disease process. Your veterinarian can help you determine the right CPR elections. You may change this election at any time by completing this form again.

Pets that are resuscitated after an arrest event often require critical monitoring for 1-3 days and may have temporary or permanent complications.

Prices listed below are an estimate and may be higher or lower based on your pet’s needs. In initialing next to your election, you are agreeing to take financial responsibility for costs accrued.

In the event of cardiopulmonary arrest, I do not want any resuscitative efforts performed on my pet. I request that my pet be allowed to pass without intervention. I will be notified of an arrest event as soon as possible. If needed, some interventions may be provided to my pet to allow for a peaceful passing, including oxygen, pain medications or sedation. This may cost anywhere from $50-$300.
In the event of cardiopulmonary arrest, I request that resuscitative efforts be performed on my pet. This includes external compressions, intubation or creation of a surgical airway, oxygen/ventilatory support, injectable medications, monitoring, defibrillation, and fluids. Internal CPR is the best form of CPR for large dogs, dogs already in surgery or dogs with fluid in their chest as a presenting concern (pleural or pericardial effusion). Performing intrathoracic CPR means that we make an incision through the chest wall (or diaphragm during surgery). This form of CPR does increase the chance of resuscitation if deemed appropriate (not appropriate for cats or small dogs). Your veterinarian will determine the best CPR for your pet. The cost of CPR may range from $250 to $1000. This does not include the cost of post-arrest monitoring and care.
Clear Signature