Owner Name
Owner Email
Pet Name
Species
Sex MaleFemale
I am the owner of the animal identified above and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure(s) or operation(s)
Admit For
Instructions I understand that during the performance of the previously indicated procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the procedure(s) or operation(s) or different procedure(s) or operation(s) then 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 judgment. I also authorize anesthetics and other medications, and 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. I realize that results cannot be guaranteed.
Pre-anesthetic blood work is recommended by the doctors in order to evaluate the internal health of your pet before his or her anesthetic procedure. JUVENILE (Under 2 years)ADULT (2-6 years)SENIOR (over 6 years)
Pain medication will be administered to all surgical patients while in the hospital. If needed, additional pain medication will be sent home at the discretion of the doctor.
I HAVE READ AND UNDERSTAND THIS AUTHORIZATION AND CONSENT.
Signature of owner/agent: (Entering and submitting name in this form and will constitute signature)
Date
Phone Number (where you can be reached the day of surgery)
Would you like your pet to get a microchip? YesNo
Medications
