13.3. HQ’s Wellness & Vaccine Consent Template

*THE BIG WHAT
The Wellness Consent form should reflect the services offered through your Wellness Calendar. Most clinics will simply offer vaccine clinics while others will offer a range of wellness care and miscellaneous anesthetic procedures outside of a spay/neuter. The consent form should be compatible in any wellness appointment type offered by your clinic.

Download HQ Recommended Templates (follow link and open HQ Templates.) AVAILABLE IN ENGLISH & SPANISH

Vaccine Clinic Consent from HQ Recommended Templates

A good consent form has four main parts:

1. Animal/Owner information such as owner’s address and an animal description.

2. Medical questions: a good idea here is to keep it as simple as possible since around 70% of clients will be filling out the form on their phone.

3. Requested services — and a way to add on any services not selected at the time of making the appointment.

4. Terms of Agreement – this is where your clinic outlines all the things the client must agree to before you will provide service, such as:
- they agree that they are the owner or animal’s representative.
- they acknowledge that even though the animal may get vaccinated today, it’s possible the vaccines will not take effect for up to two weeks.
- they understand that the veterinarian may decline their pet for vaccines/services
- they understand that the veterinarian may decline their pet for surgery (if anesthetic wellness of offered.)
- they acknowledge the hazards of any type of surgery. (if anesthetic wellness of offered.)
- they understand that it may not be possible to do a complete physical exam.
- they grant permission for your veterinarian to perform life-saving treatments or transport to another veterinary hospital without consulting the owner first and regardless of cost.
- they agree to follow the post-operative instructions.
- they consent to flea treatment if the animal is infested with fleas and the veterinarian determines it’s necessary.
- they agree to allow you to take photographs of the animal and use on social media.
- And finally, they are to not hold your clinic liable or responsible for anything that happens to animals while they are in your care.

Anesthetic Wellness Consent Considerations

If your clinic performs anesthetic wellness procedures, use the language from the spay/neuter consent form to discuss anesthesia risks in the Wellness Consent.
Here’s how:
1) Edit the spay/neuter consent form removing terms about sterilization procedures. Change the template title to Wellness Consent Form
2) Use the Vaccine Clinic Consent form and copy/paste terms from the spay/neuter consent into the Vaccine template. Change the template title to Wellness Consent Form.

Example edited HQ Recommended Template for Anesthetic Wellness Consent