Cushings Consent Form

Please complete the following details.

ACTH Stim Test and Low dose Dexamethasone Suppression Test Consent Form

Which Clinic are your visiting?(Required)

Patient & Customer Details

Insurance

Do you have Pet Insurance
If you wish to claim for today please let a nurse or receptionist know and we can submit it electronically for you.

Questions

Please record any other current medications your pet is on and when the medication was last given:
Is your pet up to date with tick/flea prevention?

Approvals

Your pet is being admitted into hospital today for a procedure or hospital treatment as outlined above. The vet will call with the results over the next few days.
Payment at Pickup
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Estimate provided by vet

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