Surgery Consent Form "*" indicates required fields Owner's Name* First Last Pet's Name*Presented for:*Upcoming Appointment Date MM slash DD slash YYYY I, the undersigned owner, agent of the owner, or Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am eighteen years of age or older. I consent to the examination, performance of lab tests/treatment prescription of medication, hospitalization, sedation, administration of anesthesia, and/or performance of surgical procedures on my pet, along with preventative healthcare based on our records by staff veterinarians and consultant surgeons at SOUTHEASTERN VETERINARY HOSPITAL, P.A. and staff. My pet was fed dinner last night at*It is our job to ensure that your pet can properly process and then eliminate the anesthetic he or she is given. Before we perform any procedure requiring anesthesia, we strongly recommend running tests to confirm that your pet's organs are functioning properly and to reveal any hidden health conditions that could put your pet at risk. I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated.Pre-Anesthesia Bloodwork Accept Decline For Pre-Anesthesia Bloodwork $67.75 (6 test) $86.00 (12 test) at Dr.'s discretion Not Applicable Certain services have mandatory bloodworkWOULD YOU LIKE YOUR PET MICROCHIPPED TODAY? ACCEPT DECLINE IF YOUR PET IS PREGNANT, DO YOU STILL WANT HER SPAYED? ACCEPT DECLINE Client Signature*Date* MM slash DD slash YYYY Phone Numbers* Add RemoveHAVE YOU TALKED WITH YOUR DOCTOR ABOUT THE FOLLOWING The medical and/or surgical treatment alternatives for your pet Sufficient details of the procedures for you to understand what will be performed How fully your pet might respond or recover and how long it could take The most common and serious complications The length and type of follow-up care and home restraint required The estimate of fees for all services Any necessary payment arrangements Questions or Concerns?NameThis field is for validation purposes and should be left unchanged.
Southeastern Veterinary Hospital