Rescue Group Agreement

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Name of Rescue Group *

Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

County

Primary Phone *

I certify that I am, in fact, the owner or authorized agent for the Rescue Group named above. I grant the veterinarians and staff of Animal Works Veterinary Surgery my consent to and authorization for procedures to be performed for any pet my organization brings to Animal Works Veterinary Surgery whether at 1002 W. Drake Ft. Collins location or mobile. I fully understand that Animal Works veterinarians are Colorado licensed Doctors of Veterinary Medicine but are not veterinary specialists and maintain and continue to give my consent. The nature of the operation or procedure(s) has been explained to me, and I understand what will be done. I understand that Animal Works Veterinary Surgery will do a brief pre-anesthetic exam on all pets prior to surgery, but not a full comprehensive exam. It is recommended that I visit a primary general care veterinarian for a full comprehensive work-up, if desired. I understand that unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above for the safety of the pets. I hereby consent to and authorize the performance of such altered and/ or additional procedures as are necessary for the veterinarian's professional judgement. I accept responsibility for any result in additional fees. I understand Animal Works Veterinary Surgery will use all reasonable precautions against injury, escape, or death of the animal but will not be held liable or responsible in any manner and thoroughly understand that I assume all risks. I agree to the use of any photograph(s) or video(s) of me, the group and/ or the pets for educational and promotional purposes of Animal Works Veterinary Surgery (including but not limited to: webpages, newsletters, brochures, and display(s). I further understand that myself or my organization will not be paid for the use of such photograph(s) or video(s). My signature certifies that I am over 18 years of age. *

I have read and understand

I fully understand that Animal Works Veterinary Surgery is a surgical center and not a 24-hour hospital. I accept these limitations of service and have been informed to take the pet to a 24-hour hospital if complications arise after surgery or treatment. On rare occasions Animal Works Veterinary Surgery may offer to keep pets overnight, I understand that no staff will be attending to the pet during this time and I assume the risk. If I choose to upon my own accord, to go to any other veterinary hospital or emergency hospital before or after surgery for the pet, I fully understand that Animal Works Veterinary will not be liable for any charges incurred from the treatment that was given at any other veterinary related facility or hospital. I understand that an orthopedic surgery may require recheck(s) under anesthesia every 1 to 2 weeks or as deemed necessary by the attending veterinarian and that any recheck(s) deemed necessary must be performed at Animal Works Veterinary Surgery. I also understand that failure to follow through with the necessary recheck(s) may severely affect the pet’s healing process. I fully understand the pet may receive medications as deemed necessary by the veterinarian. These medications include but are not limited to pain management and antibiotics. I also understand that any medication has the potential to cause adverse reactions that cannot always be predicted. If concerned, I will have the pet brought back to Animal Works or a general practice veterinarian to have these reactions addressed. I accept responsibility for any result in additional fees to the rescue. *

I have read and understand

Animal Works Veterinary Surgery requires a Pre-Anesthetic Profile for all pets 5 years of age or older. Our Pre-Anesthetic Profile checks the pet’s organ functions to see if we need to alter our anesthetic protocol or medications to go home. If the pet has recently had bloodwork performed at another clinic, please upload with other records. Each individual authorization form will ask if you would like this performed. *

I have read and understand

Intravenous Catheter Placement & Fluid administration during surgery/recovery: While not mandatory in young and healthy animals under 5 years of age, Animal Works Veterinary Surgery recommends Intravenous (IV) fluids administered during surgery to help maintain hydration, normal blood pressure and support the cardiovascular system. The pet will have a shaved area on the front of their leg as the hair must be removed to allow the area to be disinfected properly before inserting the catheter. This area will be bandaged and can be taken off once you arrive home. This service is included in all other surgeries except spay and neuters. It is required for pets 5 years of age, each individual authorization form will ask if you would like this performed. *

I have read and understand

After any surgery, it is possible the pet will want to lick or chew at the surgery site. Therefore, we recommend providing an e-collar to prevent this from happening. Any surgical complications related to a pet licking or chewing at the surgery site will be treated at an additional cost to the rescue. *

I have read and understand

I further agree to make prompt and complete payment for all treatment upon discharge any pet Animal Works has treated. I also understand and agree that in case of non-payment, I will be subject to all billing and/ or finance charges associated with the rescues’ account. Should it become necessary to settle the account through a collection agency or attorney. I, the undersigned, agree to pay all costs of collections. This agreement shall remain valid until one of the parties listed elects to void the contract. The contract can only become voidable after all agreed current services have been rendered and no payment is owed to Animal Works Veterinary Surgery. *

I have read and understand

I agree that a digitally scanned or photographic copy of this agreement and instruction shall be as valid as the original. *

I have read and understand

Signature *

Date *

Name

Rescue Group Agreement

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