Hospice Care Consent Form

Consent and Acknowledgment

Please read each statement carefully. Indicate your understanding by initialing beneath each section.

General Consent to Hospice Care

I confirm that I am the legal owner or authorized agent of the pet named above. I elect to enroll my pet in hospice care provided by Serene Passages. I understand that hospice care focuses on comfort and quality of life rather than curative treatment.

Included Initial Services

I understand that the initial hospice care package includes:

• One in-home visit
• A follow-up email with a written care plan and summary of recommendations
• Written prescriptions, if deemed appropriate by the veterinarian
• Four weekly 30-minute follow-up phone calls with the veterinarian

Overview of Services That May Be Recommended

I understand that additional hospice services may be suggested, including:

• Pain management and palliative medications
• Additional in-home visits and assessments
• Telemedicine consultations and phone calls
• Nutritional guidance
• Mobility aids and comfort support
• Emotional support for family members
• Collaboration with my primary veterinarian
• Planning for humane euthanasia and/or palliated natural death

Treatment Consent and Financial Responsibility

I understand that:

• I have the right to accept or decline any recommended treatments or medications.
• All medications, supplies, and comfort aids are billed separately.
• I accept full financial responsibility for these items.

Medication Administration

I understand that I am responsible for obtaining and administering medications and care as outlined in the plan, unless other arrangements have been made in advance.

Collaboration & Communication

I understand that hospice care is a collaborative process. I agree to maintain open communication with the Serene Passages team and notify them promptly of any changes in my pet’s condition.

Extending or Resuming Hospice Care

• I may extend hospice care beyond the initial 4-week period by notifying Serene Passages. I understand the cost is $180 per month for 4 additional weekly phone consultations.
• If I discontinue hospice services and later wish to resume, I may do so within 8 weeks of my last follow-up call.
• If more than 8 weeks have passed, a new hospice appointment will be required to resume care.

Financial Agreement

Billing and Payments

I acknowledge that:

• Payment for all services is due at the time of service.
• Additional in-home visits will incur additional charges.
• I accept full financial responsibility for all services provided under the hospice care plan.

Release of Liability

I release Serene Passages, its staff, and associated veterinary professionals and contractors from liability arising from the provision of hospice care. I understand that all care decisions are made in the best interest of my pet’s comfort and well-being.

Cancellation Policy

I understand that:

• Cancellations must be made more than 6 hours before the start of my appointment window to receive a full refund.
• If I cancel with less than 6 hours’ notice, I will be responsible for a $150 late cancellation fee, due within 24 hours.
• If I prepaid, I will be refunded the balance after any applicable fees are deducted.