Surgical Consent Form

"*" indicates required fields

Species*


Gender*




I understand that during the performance of the foregoing procedures(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedures(s) or operations(s) or different procedures(s) or operations(s) than those set forth above. Therefore I hereby consent to and authorize the performance of such procedure(s), or operation(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgement.

I also authorize the use of the appropriate anesthetics and other medications and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian.

I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. It has been recommended that pre-screening lab work be drawn prior to surgery.

All pets must be current on vaccinations, with any hospitalized procedures. If you cannot provide us with the proof of those vaccinations, we will vaccinate your pet.

Please Read & Check Box Accordingly

Authorize lab work prior to surgery/procedure being done today.*


Authorize a HomeAgain microchip to be implanted*


Require notification to dental extractions (removal of teeth) if deemed warranted by a veterinarian. Extractions are at an additional cost, unless included in an estimate (if provided).*


Need a refill on my pet's heartworm preventative.*


Need a refill on my pet's flea preventative. If evidence of fleas is seen during your pet's procedure, appropriate flea medication will be applied at an additional cost to the owner.*


Need a refill on any other of my pet's medications.*


Request an Elizabethan collar (device to prevent licking) following today's procedure.*


Request a specific time to pick up my pet.*


I have read and understand this authorization and consent.


MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.

What's Next

  • 1

    Call us or schedule an appointment online!

  • 2

    Meet with a doctor for an initial exam.

  • 3

    Put a plan together for your pet.

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