Open Everyday for Appointments • info@dullesvets.com • 25067 Elk Lick Rd. South Riding, VA 20152

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Dulles South Veterinary Center

Emergency Treatment Authorization

  • has been admitted to Dulles South Veterinary Center. To more effectively and swiftly assist your pet, we require authorization to initiate and/or continue treatments if needed to stabilize your pet. By signing this form, you are accepting financial responsibility for these treatments, including an emergency exam fee. The doctor will speak to you as soon as reasonably possible in a most-to-least critical state order of arrival and will provide you with a medical care plan (an estimate of the total expected charges, including emergency treatments).

    A deposit of the low end of the estimate is required at this time to continue treatments and will be applied to the total costs. Dulles South Veterinary Center accepts Visa, MasterCard, American Express, Discover, cash, Care Credit and Scratch Pay. WE DO NOT OFFER ANY PAYMENT PLANS.

  • CPR Status

    Cardiopulmonary Resuscitation (CPR) is an emergency procedure which is performed in the attempt to return life to an animal in cardiac or respiratory arrest. In an event of an emergency, please designate your wishes regarding this medical procedure by placing your initials on one of the lines below. We will keep this form on file, so that in an emergency we can act in your pet's best interest. We will always try to contact you as soon as possible if your pet is in an emergency state.