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EMERGENCY CARE ***NOTE***: The main reason for this clause is for the
acute, severe colic case. For many of them, time is of the essence IF
surgery is to be effective. This form, if properly filled out, will help
us give prompt treatment to your horse in the manner you wish. Should
the horse(s) you have boarded or_____________at _____________ experience
a case of colic or serious injury or illness and you are not available
for consultation, ___________should: (Circle)
Have
the attending _______________ veterinarian institute appropriate
treatment that can be carried out on the Farm, but DO NOT SHIP to a
veterinary clinic. If the attending veterinarian on the Farm cannot save
the horse(s), I authorize the horse to be euthanized.
If, in the opinion of the attending veterinarian, the horse(s) requires
prompt surgical intervention and/or intensive care in order to save its
life, SHIP THE HORSE to an appropriate equine veterinary clinic. In case
of severe colic, exploratory surgery is necessary to discover what is
causing the pain. This surgery costs approximately $1800. At this point,
the attending veterinarian at the equine clinic can give the
_____________ representative a fairly good estimate of the probability
of survival and the costs. At this time, I authorize the _____________
representative to:
A.
Have the veterinarian do whatever is deemed necessary to try to save the
horse(s) without consideration of expense.
B Have the veterinarian do whatever they can to save the horse(s),
but limit the costs to $_________. If in the estimation of the
veterinarians the horse(s) cannot be saved for the limit I am setting,
the __________representative is authorized to have the horse(s)
euthanized.
**NOTE**
Most surgical colic cases end up costing in the $3500-$5000 range.
However, some have been to $10,000 and above, depending on particular
cause and complications.
Please
circle the appropriate paragraph and initial. If you have marked the
second option, you MUST mark either A or B. BE ASSURED THAT
_______________ WILL MAKE EVERY EFFORT TO CONTACT YOU and will act in
the best interest of your horse(s) and within the limits you have
indicated.
I
have read the emergency care clause and authorize the actions I have
indicated above:
Date
Owner/Agent Signature
NAME OF HORSE(S) COVERED BY
THIS AGREEMENT
NOTE:
If your horse(s) is insured, you may required to do what is necessary to
save the animal regardless of cost to abide by the policy. Name,
address, and Phone number of insurance company:
PLEASE LIST ALL PHONE NUMBERS
WHERE WE SHOULD ATTEMPT TO CONTACT YOU.
Owner warrants that he or she owns the horse(s) and that there are no
liens against the horse(s). If an agent of Owner executes this
agreement, such agent warrants that he or she is duly authorized to act
for and on behalf of the owner.
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