AEHR Critical Check-in Form

This is the minimal information we need.

All fields are required.

Pet's name:

Species:

Breed (DSH, Lab, etc):

Age (in years):

Gender: Male Female -- Spayed/Neutered: Yes No

Client LAST name:

FIRST name:

Phone:

CPR Code (required)

In the event of a respiratory or cardiac arrest, I authorize the
doctors and staff of Animal Emergency Hospital of Redmond
to perform the following CPR efforts (select one):

DNR (Do Not Resuscitate): I understand that
no attempt will be made to resuscitate my pet.

Basic CPR: This includes ventilation support, closed chest
compressions, medications and needed diagnostics and monitoring.
An additional cost of $600-$1000 is authorized
on top of any previously discussed estimate.

Advanced CPR: This includes Basic CPR plus
more advanced life support and diagnostics.
An additional cost of $900-$1500 is authorized
on top of any previously discussed estimate.

Submitting this form authorizes AEHR to perform
$1000-1600 of immediate treatment.
We will call you as soon as we possibly can.

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Updated: 8/2/2023 11:00 am

Rest assured, we will doall we can to care for your pet.

This is the minimal information we need.

All fields are required.

CPR Code (required)

Submitting this form authorizes AEHR to perform $1000-1600 of immediate treatment. We will call you as soon as we possibly can.

Rest assured, we will do
all we can to care for your pet.

Submitting this form authorizes AEHR to perform
$1000-1600 of immediate treatment.
We will call you as soon as we possibly can.