Cave Creek Equine

Client Consent

  • Owner Information

  • Patient Information

  • Financial Information

    Payment in full is required at the completion of services. Final payment may be made by credit card, cash or check. Please note all returned checks will be charged a $35 fee. If the account is NOT paid in full at the completion of services, and after you review of the final bill, the amount due will be charged to your credit card.
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  • Please remember that Cave Creek Equine Surgical & Imaging Center (CCESIC) will not be reimbursed by your insurance company for services rendered. We would be happy to assist you in completing the required paperwork for your reimbursement once your account has been paid in full.
  • There is a cancellation fee for no shows and appointments that cancel with less than 24hrs notice.

  • Client Authorization

  • Patient Insurance

    The insurance carrier for animals is handled differently than the medical insurance carried for yourself. We are not reimbursed by the insurance companies for services rendered. Cave Creek Equine will be happy to assist in completing the required insurance paperwork for your reimbursement once the account has been paid in full.Discharge: If you are not present at the time of discharge, your completed invoice will be faxed or mailed to you and payment will be charged to the credit card you have indicated on your admission form. A copy of the receipt and your final bill will be mailed to you.
  • Consent

    I, the undersigned owner (or authorized agent for the owner), of the animal(s) described above have the authority to execute consent for this procedure and am over the age of 18 years. With full understanding of the above, I authorize the veterinarian at CCESIC and their assistants to perform the necessary examination(s), treatment(s), and diagnostics. I understand that risks and potential complications exist during veterinary procedures. If any unforeseen condition arises in the course of the procedure(s), I also authorize CCESIC to do whatever is necessary to avoid unnecessary suffering by the animal (including euthanasia). I acknowledge that no guarantee has been made as to the results that may be obtained. I understand that CCESIC is not staffed 24 hours. Furthermore, I assume all financial responsibilities for the charges incurred for this procedure. I understand that in the event that it would be necessary to utilize the services of an attorney for collection of my account to CCESIC, I agree to pay reasonable attorney’s fees, costs of collection, and all court costs. I hereby authorize CCESIC to charge my credit card until all fees are paid in full. There is a cancellation fee of $25 for no shows and appointments that cancel with less than 24 hours notice.
  • Additional Consent for Surgical & MRI Patients

  • yes/no
  • • Pre-Anesthetic Blood Testing: To ensure that the patient can properly process and eliminate anesthetic agents, it is our policy at CCESIC that pre-anesthetic blood testing be performed prior to any anesthetic procedure. These tests confirm that the patient’s organs are functioning properly as well as reveal hidden health conditions that could put them at risk. If the results are normal, we can proceed with the anesthetic procedure as planned. If the results are abnormal, we may simply need to alter the type of anesthesia used or run further tests to determine the extent of the problem and initiate treatment. There is no guarantee that the blood testing will show a potential issue, but it gives us the best chance of finding a problem before we potentially exacerbate it with anesthesia.

    • Anesthesia & Surgical Risks: The use of anesthesia and other medications for surgical or diagnostic procedures as well as the procedures themselves come with inherent risks. Although rare, these risks include, but are not limited to, abnormal reaction to anesthesia, injury during anesthetic induction or recovery, cardiopulmonary arrest and death during general anesthesia, post-operative colic, postoperative nerve paralysis, postoperative diarrhea, postoperative laminitis, surgical site wound infections, infections of the respiratory tract, and severe bleeding. The risks are greatest in animals that are very young, very old, obese, or medically compromised. At CCESIC, many precautions are taken to prevent these complications; however, some infrequently do occur. If you have any concerns or questions regarding the complications or risks associated with your animal's surgical procedure, please do not hesitate to ask one of the veterinarians to explain them further.

    Consent: I, the undersigned owner (or authorized agent for the owner), of the animal described above have the authority to execute consent for this procedure and am over the age of 18 years. The reasons why this procedure is necessary, it’s advantages, possible complications, and possible alternative methods of treatment have been discussed with me. With full understanding of the above, I authorize the veterinarian at CCESIC and their assistants to perform, under any anesthetic deemed advisable, the procedure(s) listed above. I understand that risks and potential complications exist with anesthesia and surgery. If any unforeseen condition arises in the course of this procedure, calling for their judgment for any procedure in addition to or different from those now contemplated, I also authorize CCESIC to do whatever is necessary to avoid unnecessary suffering by the animal (including euthanasia). I acknowledge that no guarantee has been made as to the results that may be obtained. I understand that CCESIC is not staffed 24 hours.

    Furthermore, I assume all financial responsibilities for the charges incurred for this procedure. I understand that in the event that it would be necessary to utilize the services of an attorney for collection of my account to Cave Creek Equine Surgical & Imaging Center (CCESIC), I agree to pay reasonable attorney’s fees, costs of collection, and all court costs. I hereby authorize CCESIC to charge my credit card until all fees are paid in full.

  • Submission

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    I have read and understand the above stipulations. By checking this box I agree with the above.
  • Thank you for choosing Cave Creek Equine Surgical & Imaging Center for the care of your horse.

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