Surgical Consent Form Surgical Consent Form Surgical Consent Form Name * Name First First Last Last Pet's Name * Email * My pet is in today for the following procedure * Is your pet currently taking any medications? * Yes No Pet Medication(s) Please list any medications that your pet is taking below Name of Medication: * Dosage/Frequency: * When was the last time dose was given? * plus1 Add minus1 Remove Any allergies to medications * ** Please Read Carefully and Sign ** Your pet is here today for anesthesia and a surgical procedure. Rest assured that advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications. Nevertheless, occasional problems can arise due to pre-existing conditions not evident during routine pre-anesthetic examinations. Please be aware that surgeries are performed throughout the day. The order is determined at the surgeon’s discretion after all patients have been admitted. You will be called when your pet’s procedure has been completed. Discharge times may be as late as 5pm-7pm. If any abnormalities are found I can be reached at the following phone number, we will send a text when the procedure is starting. Contact's Name Contact's Phone * Additional Contact's Name Additional Contact's Phone * Your pet can be micro-chipped while he/she is here today. This includes many benefits such as lost pet recovery network and 24/7 emergency medical hotline. * Yes, I would like my pet micro-chipped today. No, I decline this service today. To ensure the safety of all animals in our care, please be aware that if your pet is not fully vaccinated and contracts an illness while staying with us, we cannot be held responsible for any resulting medical cost. * I understand I, the undersigned, have read and fully understand the above information and procedures. Signature * signature keyboard Clear Today's Date * Submit If you are human, leave this field blank.
