Surgery Consent Form

Please fill out this form as completely and accurately as possible so we can
get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Pet's Name *

Emergency Phone Number *

Dental Surgeries

Sign off for bloodwork
Dental x-rays,
Whether they would like to be notified for extractions

Generalized Surgeries

Sign off for bloodwork
Whether they would like an AVID microchip placed while under sedation).

I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. Subject to my directions above, I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent. *

I have read and understand

The fees associated with these services have been explained to me, and I agree to pay such fees in full at the time my pet is released from the hospital. *

I have read and agree

Signature *

Clear Signature

Today's Date *

Name

Online Forms

Surgery Consent Form

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