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Consent for Vaccination Forms

Model 1 Consent for Vaccination

The goal of animal vaccination is to effectively reduce the extent and severity of infectious disease in our pets.

In granting this consent to vaccinate, I hereby state that:

  1. I understand that (cat’s name) may be exposed to (disease).
  2. I understand that (cat’s name) has a (state current best estimate of odds); chance of contracting (disease).
  3. I understand that vaccination of (cat’s name) with (state name & type of vaccine) will substantially reduce, but may not completely eliminate his/her chances of contracting (disease).
  4. I understand that (cat’s name) may develop (list side effects) within (state time frame of vaccination). I understand these side effects are usually minor and pass without the need for additional veterinary care. I understand that should (cat’s name) develop any severe or unanticipated reaction to the vaccination, I should contact (state who to contact and how) immediately for instructions.
  5. I understand that (cat’s name) has a (state current best estimate of odds) chance of developing a fibrosarcoma-type tumor at the vaccination site. I understand that this type of tumor, should it occur, is life-threatening and may require extensive medical or surgical treatment.
  6. I have had an opportunity to ask any questions I have concerning this vaccination. All such questions have been answered to my satisfaction.

Owner’s Signature_________________________________________Date____________

Witness Signature_________________________________________Date____________


 Model #2 Consent to Vaccination

I hereby consent to have my cat vaccinated for (state disease).

I have read and understood to my satisfaction the materials provided to me by Dr. (state name). The doctor has answered to my satisfaction all of my questions.

I am aware of the significant risks and benefits of vaccinating (state cat’s name) against (state disease).

Owner’s Signature_________________________________________Date____________

Witness Signature_________________________________________Date____________

 

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