Surgery/Dentistry Client Consent Form
Email Address *
First Name *
Last Name *
Pet's Name *
Telephone number where you can be reached during the day of your pet's procedure? *
Your pet should be fasted(not given food) after 9pm the night before the procedure. Water is ok and should not be restricted. *
Are there any new health concerns with your pet that you would like us to address, that have not been previously discussed with our veterinary staff? (eg. ear infection, lameness)
What to Expect on the Day of the Procedure
After your pet is dropped off for their procedure a doctor will complete a thorough physical exam. If blood work hasn't yet been performed, we will draw and run these samples in our in-house laboratory. Blood work ensures that your pet's organ function is capable of safely metabolizing anesthesia. We usually have multiple surgical procedures on a given day and our veterinarians will triage the patients and establish an order of procedures. Critical/Unstable patients receive surgical intervention earlier in the day. For this reason, your pet may have surgery later in the day which may result in a discharge later in the evening. Our doctors/technicians will call you when your pet is in anesthesia recovery and provide you with a summary of the procedure and set up a discharge time.
Treatment Authorization
I understand that risks 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.To better understand our anesthesia protocols at our hospital please visit the anesthesia page of our website:
By checking the box below, I certify that I am the owner or agent of the owner of the above named pet and I have the authority to make medical decisions related to the pet. I authorize the Douglassville Veterinary Hospital staff to provide care and perform any treatment (including the administration of anesthesia and surgical procedures) they consider reasonable and necessary for my pet. *
Acceptance of Financial Responsibility
I understand that payment in full is required at the time of service. Douglassville Veterinary Hospital staff will provide an estimate of fees upon my request. I acknowledge that an estimate is only an approximation; actual fees may vary. I recognize that I am responsible for all charges related to my pet. *
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