Pet Information

Pet's Name *

Contact Information

Name *

First

Last

Email *

Phone *

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is: (example: lump removal, exam, etc.) *

Additional Services Desired While Patient Is Sedated

Please select any/all that you would like us to provide while your pet is sedated

Please specify the additional service(s) you'd like provided to your pet *

Authorization

I authorize surgery for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with surgery and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. *

I have read, understand, and authorize

Payment due upon services rendered. *

I have read, understand, and agree.

I have read and fully understand this consent form *

Yes

Signature *

Clear Signature

Date *

ONLINE FORMS

Consent Form

Pet Information

Contact Information

Additional Services Desired While Patient Is Sedated

Authorization

Ready for an Appointment?

Have a Question?

Location

Contact Information

Business Hours