Surgical Consent Form printable pdf download

Date of Surgery:__________

THE PET VET ON PATTON

ANIMAL HOSPITAL

SURGICAL CONSENT FORM

OWNER NAME: _______________________________________________________________

PET NAME: _________________________________________________________________

PROCEDURE: _________________________________________________________________

PHONE NUMBER FOR TODAY: _______________________________________________

CELL PHONE NUMBER: _________________________

Would you like us to send you a text picture of your pet after the procedure today?_______

Is there anything else you would like us to do for you today? _______________________

________________________________________________________________________

Would you like to have your pet micro-chipped while under anesthesia? ($55.00) __________

Would you like your pet to have a post surgical, therapeutic laser treatment to promote healing

and reduce pain? ($25.00)_________________

I authorize The Pet Vet on Patton Animal Hospital to perform the above procedures, as well as

additional diagnostic, therapeutic, or surgical procedures as deemed necessary by the veterinarian

should unforeseen conditions or complications be revealed. I understand that hospital support

personnel will be involved in my pet’s care.

The nature of the procedures(s) has been explained to me and no guarantee has been made as to

the results or cure. I understand that risks exist for any anesthetic or surgical procedure.

If the doctor finds that additional, non-emergency procedures are needed for my

pet today:

(PLEASE MARK THE ONE OPTION THAT BEST DESCRIBES YOUR WISHES)

___ Proceed with any treatment needed, including dental X-Rays, oral surgery or teeth

extractions, or medications administered in hospital or sent home. I understand additional costs

will be involved.

___ Do not perform any additional procedures, besides those previously discussed. I understand

that my pet may need to be re-anesthetized at my expense in order to perform the additional

procedures in the future.

I UNDERSTAND PAYMENT IS REQUIRED ON THE DAY SERVICES ARE PROVIDED.

I hereby certify that I am the owner or agent for the above named pet.

I have read and understand this authorization and consent form and accept the terms as stated

above.

SIGNATURE: _____________________________________

DATE:__________

This Consent Form will expire in 60 days

Surgical Consent Form