Surgery Authorization Form

Save time ahead of your pet’s surgery! Complete your required authorization form online before your visit.

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Surgery Authorization Form

Please fill out this form as completely and accurately as possible so we can best prepare for your pet’s procedure.

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Surgery Authorization Form

Client *

First

Last

Phone *

Email *

Patient *

I am the owner or the agent for the owner of the animal described above, and I have the authority to execute this consent.

I have also been informed that certain risks and complications are associated with any operation or procedure of this type. I further understand that unforeseen conditions may arise during the operations or procedures that may necessitate the performance of additional procedures.

I realize that no guarantee or warranty can ethically or professionally be made regarding the results of the procedure.

Pre-anesthetic Screening

We highly recommend that any animal going under anesthesia have a pre-anesthetic blood test done the day of surgery. These tests allow us to verify proper organ function (prior to anesthesia) and to establish a baseline for future reference. All pets 6 years of age and older will be required to have pre-anesthetic bloodwork.

I do not authorize the pre-surgical bloodwork. (My pet is under 6 years of age.)
I do authorize the recommended pre-surgical bloodwork.
Pre-surgical mini-panel $80
Pre-surgical general health profile $188

Tattoo

We offer to place a tattoo along the surgery site, at no charge, to indicate that your pet has been spayed or neutered. This is helpful in the case should your pet go missing.

I do not request a tattoo.
I do request a tattoo.

I understand that if my animal is in heat, pregnant, or obese at the time of surgery, there will be an additional cost. (Dogs...$80, Cats $65)

Microchipping

Losing a pet may be easier than you realize. 1 in 3 pets go missing during their lifetime. Without ID, 90% of pets never return. Microchipping can provide peace of mind with a permanent, lifetime ID.

I do not request a microchip.
I do request a microchip. (Implantation... $79.00, HomeAgain 1 year annual registration fee of $22 included.) total $101.00

I HAVE READ THIS DISCLAIMER, UNDERSTAND WHAT IT SAYS, AND AGREE TO IT. I CERTIFY THAT I AM 18 YEARS OF AGE, AND I AM ASSUMING FULL FINANCIAL RESPONSIBILITY FOR THIS ANIMAL.

Signature *

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Date *

phone

E-mail

Surgery Authorization Form

Surgery Authorization Form

Surgery Authorization Form

Pre-anesthetic Screening

Tattoo

Microchipping

I HAVE READ THIS DISCLAIMER, UNDERSTAND WHAT IT SAYS, AND AGREE TO IT. I CERTIFY THAT I AM 18 YEARS OF AGE, AND I AM ASSUMING FULL FINANCIAL RESPONSIBILITY FOR THIS ANIMAL.

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