Anesthetic Consent Form

YesNo

YesNo

YesNo

YesNo


YesNo


YesNo


YesNo

Elective Procedures

Home Again Microchip identification $59.50
Hip Dysplasia Screening X-ray
Ear Cleaning $12.00

We strive to keep a pest free environment for your pet so we require that any internal parasites (worms) or external parasites (fleas and ticks) identified on your pet will be treated at owner's expense.


I DoI Do Not


I DoI Do Not

You are to take all reasonable precaution against injury, escape, or death of my pet. I understand that anesthesia and surgery always involves some risk to my pet (such as unknown internal physical abnormalities, medication allergies, surgical complications, internal bleeding, shock, incision dehiscence, and post surgical infections) and I agree to hold you harmless, in the absence of negligence, in connection with these procedures. I acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. In the event complications arise and I cannot be immediately contacted at the below listed phone number, you are directed to make the decision you deem fit best for my pet. I agree to pay for the services rendered.

I have read the foregoing, understand what it says, and agree.

Signature:

Please go to Pre-Anesthesia Blood Screen Consent Form and fill out completely.