Surgical Consent Form CLICK HERE to Print the Surgery Consent Form OR fill out and submit the electronic version below Pet Name*Pet Owner/Authorizing Agent Name*Email* Phone number at which I can be reached immediately and at all times today.*I am the owner or agent for the above described pet and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure(s): I understand that during the performance of the aforementioned procedure(s), unforeseen conditions may be revealed that necessitate the extension of the procedure(s) in addition to those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as necessary and desirable in the exercise of the veterinarian's professional judgement. I also authorize the use of appropriate anesthetics, analgesics, fluid therapy and other medication, and I understand that the judgement of hospital support personnel will be employed as deemed necessary by the veterinarian (e.g. to control post-operative pain). have been advised as to the nature of the procedure(s) and the risks involved. I realize that results cannot be guaranteed. PRE-ANESTHETIC BLOOD TESTINGBefore placing your pet under anesthesia we will perform a physical examination. However, many conditions, including disorders of the liver, kidney, or blood, are not detected unless blood testing is performed. Such tests are especially important before any kind of surgery. For these reasons, we highly recommend blood screening before such procedures. Please choose one of the following: Please choose one of the following:Yes, I want my pet to have a BASIC pre-anesthetic blood screen at a cost of $65.55Yes, I want my pet to have a FULL pre-anesthetic blood screen at a cost of $170.69 (full chemistry and CBC)No, I do not want my pet to have a pre-anesthetic blood screenMICROCHIPPINGMicrochips are small identification chips implanted under your pet's skin. Each chip has a unique number connected to your information. This can be done painlessly while under anesthesia today. Please choose one of the following:Yes, I would like my pet to receive a HOMEAGAIN microchip for $54.39. This includes the microchip, one time registration fee, and a 1 year membership.No, I do not authorize my pet to be microchipped todayMy pet is already microchippedPAYMENT POLICYI understand payment is expected in full at the time services are provided and I assume full financial responsibility for all procedures and products. I agree to make full payment using one of these forms: cash, check, debit, Visa, MasterCard, Discover, and AMEX. If you accept the terms of our payment policy, select "I Agree" below* I Agree Signature Field ("sign" your name by typing your name in this field)CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
