Emergency & Cardiopulmonary Resuscitation (CPR) Authorization

In the event my pet experiences cardiac arrest, respiratory arrest, or life-threatening emergency while under the care of The Welcome Waggin’

I authorize the following, please select ONE option (initial choice):

NO CPR - I direct that no cardiopulmonary resuscitation (CPR) be performed. I understand this means no chest compressions, assisted ventilation, or emergency medications, and I request that my pet be allowed to pass peacefully with comfort-focused care.

YES – LIMITED CPR

I authorize the veterinary team to initiate limited CPR measures, which may include:

• External chest compressions

• Assisted ventilation (oxygen and/or manual breathing support)

• Emergency medications as medically indicated

• Defibrillation is NOT available at this facility

• Open-chest CPR is NOT performed

• CPR outcomes in veterinary patients are unpredictable, and survival—even if circulation returns—cannot be guaranteed

Important Medical & Outcome Disclosures

I acknowledge and understand that:

• CPR is a physically aggressive intervention that may result in complications including rib fractures, internal injury, neurological damage, or prolonged critical illness

• Even if CPR is initially successful, my pet may not regain normal mental or physical function

• The veterinary team may discontinue resuscitation efforts if, in their professional medical judgment, further attempts are unlikely to result in a meaningful recovery

• If I cannot be reached promptly during an emergency, I authorize the attending veterinarian to act in my pet’s best interest using reasonable medical judgment, including the decision to discontinue CPR

Emergency Treatment Authorization

In accordance with Illinois law and accepted veterinary medical standards, I authorize The Welcome Waggin’ to provide emergency medical treatment without prior approval if immediate care is necessary to prevent suffering, serious harm, or death and I cannot be reached in a timely

manner.

This may include, but is not limited to:

• Oxygen therapy

• Emergency medications

• Intravenous fluids

• Diagnostic testing deemed immediately necessary

Financial Responsibility

I understand and agree that:

• Emergency and CPR services incur additional costs(~$350-450 per 15 minutes)

• I am financially responsible for all services rendered, regardless of outcome

• Payment is required in accordance with The Welcome Waggin’s financial policies

Client Acknowledgment & Consent

I certify that:

• I am the owner or legally authorized agent for the pet listed above

• I am 18 years of age or older

• I have read and understand this authorization

• All my questions have been answered to my satisfaction

I knowingly and voluntarily consent to the selections and authorizations above.