Surgery Consent Form

Thank you for choosing Parkside Animal Hospital for your pet’s surgery. To allow us to proceed with their care, please complete our online Surgery Consent Form.

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Surgery Consent Form

Please fill out this form as completely and accurately as possible to continue with your pet’s care.

Owner's Name *

First

Last

Email *

Phone *

Patient's Name *

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent.

I hereby give Dr.Cox, Parkside Animal Hospital, and any authorized agents, staff, or representatives consent and authority to perform the following procedures or operations:

Pre-Anesthetic Blood Testing:

The health of your pet is our foremost concern. We want to ensure your pet’s overall health prior to administering any type of anesthesia. We perform a physical examination on all patients undergoing anesthesia, then calculate a specific anesthetic dose. However, many conditions that may affect how your pet responds to anesthesia cannot be detected without diagnostic blood tests. For these reasons, we strongly recommend that all patients receive blood work prior to any general anesthetic procedure. *

YES, I want my pet to have a blood test performed before anesthesia
NO, I decline this blood test

Pain Management:

Research has indicated that some pets appear to withstand pain better than humans, they still experience postoperative pain. This pain can have considerable affects upon how well your pet recovers from the surgical procedure. If you wish, we can administer pain medication during surgery to aid in the recovery process. In most cases that injection will not have long lasting effects. Additional pain medication can effectively control your pets discomfort and help aid in your pet’s recovery at home. *

YES, I would like my pet to have pain medicine during surgery $38.00.
NO, I decline pain medication for my pet and understand that this might delay the healing and recovery process.

Miscellaneous:

While your pet is under anesthesia, we are able to perform many convenient procedures such as nail trims, general ear cleaning, or vaccinations.

YES, I want my pets nails trimmed ($16.00).
YES, I want my pets ears cleaned ($31.00).
YES, update vaccinations (According to Vaccinations that are needed).

I, being responsible for the above animal, have the authority to grant my consent for treatment, prescriptions, and/or surgery for my pet as noted above. I understand that the Hospital will use all reasonable precautions to prevent injury, escape, or death of my pet, but will not be held liable or responsible in any manner, as I fully understand and assume all risks.

My signature below indicates that I have read and had the above information explained to me, and that I release Parkside Animal Hospital and its staff from any liability in the event of a surgical or anesthetic complication.

I AGREE TO PAY IN FULL FOR ALL SERVICES RENDERED.

Client Signature *

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Today's Date *

In case of an emergency, where can you be reached? *

Please select the method you prefer: *

Text Message
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Surgery Consent Form

Surgery Consent Form

Pre-Anesthetic Blood Testing:

Pain Management:

Miscellaneous:

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