Email(Required)

Phone number(s) where I can be reached TODAY:(Required)

Pet’s Name(Required)

Anesthetic and medical or surgical procedure(s) to be performed(Required)

What medications and/or supplements are your pet currently taking?

Date last given?

My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

The reasonable medical and/or surgical treatment options for my pet

Sufficient details of the procedures to understand what will be performed
How fully my pet will recover and how long it will take
The most common and serious complications
The length and type of follow-up care and home restraint required
The estimate of the fees for all services
Any necessary payment arrangements

Signature(Required)

Date(Required)

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Phone

This field is for validation purposes and should be left unchanged.

Anesthetic Consent Form