Surgery Consent Form

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Surgery Consent Form

Owner Name(Required)

First Last

Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Pet's Name(Required)

Species(Required)

Breed(Required)

Color(Required)

Sex(Required)

Age(Required)

Procedure being performed today:(Required)

Did your pet eat this morning?(Required)

Yes

Please Read the Following Requirements:

ALL pets must be current on Rabies and Bordetella Vaccine: If your pet has had one you WILL need to show proof, or we will have to administer this vaccination and there WILL be a charge added.(Required)

I understand and accept.

The Following are NOT Included with Surgery Prices:

Pre-Anesthetic Blood Testing - Like you, our greatest concern is the well-being of your pet. Before putting your pet under anesthesia, we will do a physical examination. However, many conditions including disorders of the liver, kidneys, or blood are not detected unless blood testing is performed. For the safety of your pet, we highly recommend blood screening before any anesthetic procedure. The cost for this is NOT INCLUDED in the surgery price. Pre-anesthetic blood work is $85.00.(Required)

Yes, I accept, I want my pet to have the blood work.

No, I do NOT want my pet to have the blood work (I understand the risk during anesthesia).

I hereby consent and authorize the veterinarian on duty, and designated assistants to prescribe for and administer treatment as is considered therapeutically or diagnostically necessary. I also consent to the administration of anesthetics and surgical procedures requested or as deemed necessary by the attending veterinarian. I understand that veterinary care during the night-time house and/or weekend is provided at the discretion of the attended veterinarian. Continuous presence of personnel may not be provided during these hours. I hereby certify that I have read and fully understand the authorization for medical and/or surgical treatment, the reason why the surgery is necessary, its advantages and possible complications, as well as possible alternative modes of treatment. The veterinarian will use reasonable precautions for the well-being of this animal but will not hold liable for conditions beyond his or her control. A health care plan for the amount of services will be provided upon request. A deposit may be required prior to services. All charges are due and payable upon patient's release.(Required)

Name(Required)

First Last

Date(Required)

Please remove any collars or leashes as we will NOT be responsible for any lost or damaged items left behind.

Let’s work together to keep your pet happy and healthy!

It is our mission at English Veterinary Care to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet’s first adventure throughout a long and healthy life.

Surgery Consent Form