Surgery Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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Dalmatian dog wearing elizabethan plastic cone medical collar around neck for antibite wound protect

Surgery Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Pet's Name *

Pet's Age

Emergency Phone Number *

When was the last time pet was fed? *

Anything else needed while pet is under anesthesia?

I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. Subject to my directions above, I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent. *

I have read and understand

Signature *

Today's Date *

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Surgery Form

Surgery Form

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