HomeClient CenterOnline FormsSurgical Consent Form Surgical Consent Form Client Name* First Last Patient Name*Patient Age*Procedure*Date* Date Format: MM slash DD slash YYYY My pet is up-to-date on vaccinations.*YesNoParasite Consent* I understand that if external parasites (i.e. fleas, ticks, etc.) are present at the time of admittance to hospital, my Pet will be treated according to the doctor’s recommendations at an additional cost to me.*My pet is currently receiving heartworm prevention or has tested negative within the past 30 days.*If pet is not currently on heartworm prevention, we will perform a heartworm test.YesNoAre there any specific problems that need to be checked today?*You will be charged the full physical exam.YesNoPlease state concerns.*Did your pet eat this morning?*YesNoIs your pet allergic to any drugs?*YesNoList drug allergies.*Is your pet currently on any medication?*YesNoList medications.*Anesthesia Consent* I understand the procedure to be performed requires use of anesthesia.I give permission for the performance of any life-saving procedures deemed necessary by the attending veterinarian.*YesNoFor Reproductive Procedures (Males) I understand there will be an additional charge if both testicles are not located in the scrotum. (Females) I understand there will be an additional charge if my female animal is in heat, pregnant or severely overweight. NOTE: Each of these scenarios requires additional time and materials.Reproductive Consent* I understand the statement above.Consent* I understand and accept the risks and financial responsibility for my pet related to this procedure in accordance with the elections above.Electronic Signature of Pet Owner/Authorizing Agent*How would you like us to contact you today?*Phone CallTextEmailOtherEmail* Phone Number*Other Contact*Please be sure to be available for some communication throughout the day as we may be calling while your pet is under anesthesia.CAPTCHANameThis field is for validation purposes and should be left unchanged. Get Directions Appointments We will do our best to accommodate your busy schedule. Schedule an appointment today! Request An Appointment Request A Boarding Reservation Please complete the appropriate form to request an appointment. Please note that you do not have an appointment until you receive confirmation from us. Thank you!