Surgery Consent Form » Bird & Exotic Veterinary Clinic

Primary Owner Name *

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Daytime Phone Number *

Can we text you at this number? *

Yes
No
Do not text me

Does this number receive text messages. We may text you updates on your pet throughout the day, if applicable.

Patient Name *

Procedure(s) to be Performed

Pet History *

Did your pet eat this morning?

Do you have ANY concerns with your pet’s health you would like the doctor to be aware of? If so, please describe them briefly.

Does your pet take any medications? If so, please list them here along with when they last received them.

Additional Services Offered

These services, some performed at an additional cost, can be rendered at the same time as the surgery. Please select any if desired.

I am the owner (or the representative of the owner) of the animal presented and have the authority to execute this consent. The nature of the procedure(s) has been explained to me and I realize that the results cannot be guaranteed. I hereby consent and authorize this hospital to perform the above anesthetic procedures and/or surgery. I understand the doctors and staff will use all reasonable precaution against injury, escape, and/or death of my pet. I understand that all anesthesia involves some minimal risk to my pet and I will not hold the doctors or staff responsible under any circumstances. I understand that I assume all risks and take financial responsibility for services rendered. *

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