Surgical Consent Form

Surgical Consent Form

For your convenience, we offer patient forms online so you can complete them anywhere at any time and expedite your check-in. Alternatively, you can download & print the form, and bring the completed form on the day of your pet’s appointment.
Please Note: Due to the current pandemic, our staff is no longer allowed to accept forms at the time of the appointment. Please complete and submit all forms online. Thank you for your understanding as we try to keep everyone safe.

    I am the owner for the above named animal and have the authority to execute this consent for the performance of the following Procedure(s) or operations(s):


    I understand that during the performance of the foregoing procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) or different procedure(s) or operation(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 appropriate anesthetics and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian.

    Presurgical work costing $75 additional is required for animals five (5) years or older to help determine anesthetic risk and help reveal hidden organ dysfunction.

    My animal is on an empty stomach and has had no food since 12 midnight last night for procedures requiring sedation and anesthesia.

    SPAY — My female animal is not in heat or pregnant. If she is, spay surgery will be at an additional cost because of increased risk of complications or may not be done at all.

    My pet has acted normally for the past 24 hours — no coughing, vomiting, diarrhea, eating garbage, or other signs of illness.

    I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required.

    All payments are due at the time of services rendered.

    I have read and understand the above statements and agree to all terms therein.