14.3. HQ's Wellness & Vaccine Consent Template

Wellness Consent Form Overview.

• The Wellness Consent form should be inclusive of all services offered through your Wellness Calendar.
• Most clinics offer vaccine clinics only, while others offer a wider range of wellness care and miscellaneous anesthetic procedures outside of spay and neuter services.

Download HQ Recommended Templates
Templates are available in English and Spanish.

Wellness Consent Form Structure.

A well-designed wellness consent form contains four main sections.

1. Animal and owner information, including owner address and animal description.
2. Medical questions, which should be kept as simple as possible since most clients complete forms on their phone.
3. Requested services, including a method to request services not selected at the time of scheduling.
4. Terms of agreement outlining conditions that must be accepted before services are provided.

Terms of agreement commonly include the following acknowledgements.

• The client agrees they are the owner or authorized representative of the animal.
• The client acknowledges vaccines may take up to two weeks to become effective.
• The client understands the veterinarian may decline the animal for vaccines or services.
• The client understands the veterinarian may decline the animal for surgery if anesthetic wellness is offered.
• The client acknowledges the risks associated with any surgical procedure if anesthetic wellness is offered.
• The client understands a complete physical exam may not be possible.
• The client grants permission for life-saving treatment or transport to another veterinary hospital without prior consultation and regardless of cost.
• The client agrees to follow all post-operative instructions.
• The client consents to flea treatment if the animal is infested and treatment is deemed necessary.
• The client agrees to allow photographs of the animal for social media use.
• The client agrees not to hold the clinic liable for events occurring while the animal is in the clinic’s care.

Anesthetic Wellness Consent Considerations.

If your clinic performs anesthetic wellness procedures, anesthesia risks must be addressed within the Wellness Consent form.
Language from the spay and neuter consent form can be used to ensure appropriate disclosure.

Follow one of the methods below.

1. Edit the spay and neuter consent form.
2. Remove all references to sterilization procedures.
3. Update the template title to Wellness Consent Form.
4. Incorporate information from the Vaccine Clinic Consent for non-surgical wellness.

OR

1. Use the Vaccine Clinic Consent form.
2. Copy and paste anesthesia-related terms from the spay and neuter consent form into the vaccine consent template.
3. Update the template title to Wellness Consent Form.