Sharing of Information: As a referral practice we work as partners with your pet’s other veterinarians. We request permission to share medical information regarding your pet’s care here at AES providing integrated care for your pet. Referral reports are sent to your pet’s vets updating them on the treatment and progress of eye conditions. We also request permission to use photos and anonymous medical info from your pet’s medical record to advance the field of veterinary ophthalmology.

I do     I do not *       authorize AES, Inc. and its doctors/staff to share my pets information with other veterinarians/clinics currently or prospectively involved in their health care. Additionally, I agree that my pet’s health information/photos may be shared anonymously for collaborative papers and educational purposes.
Owner or Agent Initials    *    

Resuscitation Directive for your pet while he/she is in our care:

We strive for the utmost safety for your pet. The potential for an unforeseen medical emergency is very low for healthy pets. In the rare circumstance that something unexpected occurs with your pet's health status, we want to be prepared to act immediately per your decision on care and treatment.

In the event of an emergency, the doctors and staff of Animal Eye Specialists of silicon Valley will make every effort to contact you and involve you in decisions regarding your pet's care.

CPR treatment measures have a minimum cost of $600 and does not include costs of care if we transfer your pet to an Emergency Clinic. Any additional charges for treatment at an Emergency Clinic would be paid to that clinic directly.

Please initial below either CPR or DNR for your pet's directive. If no initials are present, we will default to CPR status. Please let us know if you have any questions.
Type here    CPR    Type here    DNR

Missed Appointment Policy:
A missed appointment is a loss for everyone; your pet whom we were scheduled to help, the other pet who we couldn’t schedule, and the doctors and staff who had reserved their time to assist your pet. For these reasons we REQUIRE 24 hour notice if you can’t make your pet’s appointment. We understand that there can be occasional unforeseen circumstances; we reserve the right to charge for missed appointments and if needed institute a pre-payment policy for future appointments.
Owner or Agent Initials:    *    

Payments: Payment in full is due at the time services are rendered. If your pet needs surgery or other procedure, you will be asked for a deposit at the time the surgery appointment is scheduled. Animal Eye Specialists, Inc. accepts the following forms of payment: Cash, Visa, Master Card, Discover, and American Express. For Care Credit or Scratch Pay options, please consult the staff