Surgery Consent Form

First Name *

Last Name *

Phone *

Alternative Number *

Client ID

Date ( MM/DD/YYYY) *

Ovariohysterectomy

Castration

Dental

Other

Preoperative Procedures : A complete blood work panel is recommended for all dogs/cats over age of 7

Choose All That Apply

Health Screen

Radiographs

EKG

Additional Procedures : Please note that any additional procedures will be at an added cost and will not be included in any price quote should one have been made prior to surgery.

Please Answer All That Apply

Microchip Placement?
Baby Teeth Removal?
Vaccines?
Any other Concerns?
Refills on preventions or medications?
In the case of a dental do you wish to be contacted prior to extractions?

E-collar: Unless otherwise indicated by the doctor we highly recommend your pet always have an e-collar on until their surgical site has healed. We can provide one here or you may bring one in for your pet to wear.

E-Collar

I understand that during the performance of the anesthetic procedure(s), unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect Hometown Pet Care Center to use reasonable care and judgment in performing the procedure(s). I am aware of the risks of the above anesthetic procedure(s) and realize that results cannot be guaranteed.

I do not hold Hometown Pet Care Center responsible nor liable should any complications including death occur. I am also aware that unforeseen events or complications resulting from the anesthetic procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding this animal.

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I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.