Surgery Anesthetic Procedure Authorization 2018-04-12T21:10:12+00:00

Step 1 of 2

  • Surgery - Anesthetic Procedure Authorization

  • I, the undersigned owner or agent of the owner of the pet identified above, certify that I am of eighteen years of age or over and authorize the veterinarian(s) at this practice to perform the above procedure(s). 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(s) is/are initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:
    • The reasonable medical and/or surgical treatment options for my pet
    • Sufficient details of the procedures to understand what will be performed
    • How fully my pet will recover and how long it will take
    • The most common and serious complications
    • The length and type of follow-up care and home restraint required
    • The estimate of the fees for all services
    • Any necessary payment arrangements
    While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. I agree to pay the estimated fees, assume financial responsibility for the remaining fees, and provide payment in full at the time my pet is discharged from the hospital. Should an unexpected critical situation arise (choose one):
  • We will call you after your pet's procedure to schedule a pick-up time.
    What time are you available to pick up your pet today?
    (your pet may not be ready to go home by this time).
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  • I have read and understand the nature of the above procedures and give my consent to proceed.