Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Email *

Patient's Name *

Breed *

Sex *

Male
Neutered Male
Female
Spayed Female

Weight *

Anesthetic/surgical procedure(s) to be performed *

I am the owner (or authorized agent of the owner) of the animal described above and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I also understand that after surgery is completed for my pet, if I choose to leave my pet at the facility after business hours and/or overnight, there will not be any hospital team members on site to care for my pet in the event of an emergency. I have carefully read, and fully understand this consent. The fees associated with these services have been explained to me, and I agree to pay such fees in full at the time my pet is released from the hospital. *

I have read and agree

CPR Consent *

I give permission for CPR
I do not give permission for CPR

I understand dental procedures include dental radiographs to identify any diseased teeth that warrant extraction. I understand the attending veterinarian cannot foresee the number of extractions needed until full mouth radiographs are taken. *

I have read and agree

Dental Extractions *

I give my permission to extract any teeth the veterinarian deems diseased and/or damaged during the dental procedure
I do NOT give my permission to extract any teeth without notification. I wish to be notified during the dental procedure of any extractions that may be needed

Signature *

Today's Date *

Dental Consent Form

Dental Consent Form

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