Veterinary Surgical Consent Form printable pdf download

Veterinary Surgical Consent Form

Owner Name:

Pet Name:

Age:

Sex:

Surgical Procedure:

Surgery Date:

Time:

Owner Phone No.:

Cell No.:

My Pet…

Has not eaten since midnight of the night before the surgery

Does not have fleas, ticks or mites

Is up-to-date on vaccines

Does not have heartworm or Feline Leukemia

Has your pet ever had problems linked to surgical procedures (seizures, diarrhea vomiting, etc.)?

Yes:

Does your pet have any allergies?

Yes:

An Elizabethan collar is available for a small price in order to keep your pet from reopening the site.

Would you like to add it to the cost?

Yes

Would you like the doctor to microchip your pet during the procedure?

Yes

I understand that any anesthesia involves some risk to my pet and I agree that I will not hold the assistants

or doctors liable or responsible in any manner for the injury, escape or death of my pet in connection with

the procedure. I will discuss any questions or concerns that I have with my veterinarian before the

procedure. I grant my consent for this procedure. I agree to pay in full for the services rendered.

Signature

Date

Veterinary Surgical Consent Form