847-934-1535
arlingtonparkvethospital@gmail.com
Facebook
Instagram
Facebook
Instagram
Home
About
Our Story
Our Team
Reviews
Photo Gallery
Services
Resources
Our App
Online Forms
New Client Form
Surgery Consent Form
Links
Careers
Contact
Appointment
Select Page
Online Forms
Surgery Consent Form
Get Started
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.
Please enable JavaScript in your browser to complete this form.
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
*
Comment
Submit