Surgical Consent Form printable pdf download

Surgical Consent Form

Pet’s Name _________________________ Owner’s Name_____________________________

Phone Number(s) where you can be reached during surgery (very important!)

__________________________

ALL PETS ADMITTED MUST BE CURRENT ON THEIR VACCINATIONS AND MUST BE

FREE OF EXTERNAL AND INTERNAL PARASITES. ANY PET FOUND TO HAVE FLEAS,

TICKS, OR INTESTINAL WORMS WILL BE TREATED AT THE OWNER’S EXPENSE.

Dogs- Current on Rabies, DHLPP/DA2PP, Bordatella (kennel cough), and intestinal parasite check

within one year. Cats- Current on Rabies and FVRCP

SURGICAL PROCEDURE:

Spay (for females) Complimentary nail trim, anal gland expression and ears cleaning included.

Neuter (for males) Complimentary nail trim, anal gland expression and ears cleaning included.



Growth/Tumor removal- Do you want sample sent out to be further analyzed? YesNo



Other: ______________________________________________________________________

PREANESTHIC PROTOCOL/LABORATORY TESTS:

Preanesthetic bloodwork is a safety screening to assure proper organ function, clotting ability, detect

anemia or infection, and a baseline for future reference. IV fluid therapy maintains blood pressure,

replaces blood loss, speeds recovery, and can be used to administer emergency life-saving drugs.

If you have any questions, please ask to speak to a veterinarian. IV fluids are given at the

veterinarian’s discretion. **If Antibiotics are required, do you prefer liquid or tablet form, if

given a choice?

ADDITIONAL SERVICES REQUESTED (while under anesthesia):

Microchip (Permanent identification recognized worldwide)

PRE-SURGICAL DEPOSIT REQUIRED

Major surgeries, critical care, and emergencies require an advance deposit.

I understand that during the performance of this procedure, unforeseen conditions may be revealed

that require an extension or variation of the procedure(s) listed above. I expect Long Trail Veterinary

Center to use reasonable care and judgment in performing the procedure. The nature of the procedure

and risks involved has been explained to me and I realize results cannot be guaranteed. I am also

aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation

to all reasonable costs incurred regarding the pet’s care.

Signature of Owner/Agent

______________________________________________Date___________________

Initials of Staff Member_________ Date________

Surgical Consent Form