Anesthesia / Surgery / Treatment Consent Form

In-Patient Questionnaire

(Pets that are overdue for vaccines are required to be made current during time of hospitalization.) To lessen risk of surgery for your cat, the FELV/FIV Test is highly recommended for all cats not currently vaccinated for the feline leukemia virus.

To lessen risks of anesthesia/surgical procedures all dogs over the age of 6 months must be current on heartworm testing and/or preventative medication.

Microchip Registration Form

AUTHORIZATION

I verify I am the owner (or Authorized agent for the owner) of the above named pet and authorize the above procedures to be performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian.

I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always a risk associated with any anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian's professional judgment. I accept responsibility for any result in additional charges.

I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. I understand no staff will be attending to my pet overnight (pets needing special care may be referred to a 24 hour hospital).