Surgery Consent Form

Anesthesia and Surgical Consent Form

Please complete this form before your pet’s surgery day. If you have any questions, please feel free to contact us! Please Note: Any fields with * are required.

Name *

First

Last

Email *

Pet's Name *

Phone number at which owner can be reached: *

Additional Number: *

When was the last time pet was fed? *

Would you like us to text you after the procedure, or would you prefer a call?

Text
Call

Would you like us to microchip your pet during the procedure? (There is an additional fee)

Yes
No
Already has one.

I am over 18 and understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. I do hereby give All Paws Veterinary Clinic, agents, doctors, and/or representatives the full and complete authority to perform the surgical procedure. If unable to contact me, the staff may or may not have my permission to proceed with life-sustaining procedures. While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow-up radiographs, re-check physical exams, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. *

I have read and agree.

Date *

New Clients: Receive $25 off your first visit!

All Paws Veterinary Clinic

Surgery Consent Form

Anesthesia and Surgical Consent Form

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