Pre-Surgical Consent Form


MM slash DD slash YYYY

Would you like to update your pets vaccines today?

Annual exam(Required)


Heartworm/Ehrlichia/Lyme test(Required)


Rabies(Required)


DHPP(Required)


Lepto(Required)


Bord(Required)


Lyme(Required)


K9 Influenza(Required)


FVRCP(Required)


Felv(Required)


Has your animal been fasted for the last 12 hours pre-surgically?(Required)


Is your animal on heartworm preventative?(Required)


We require testing prior to surgery if your dog is not currently on preventative or if the last test was
more than two years ago.

Would you be interested in getting a microchip for permanent identification of your pet?(Required)




Price: $89.95
I am the owner (or agent of the owner) of the animal named above. I authorize you to perform surgery,
hospitalize, complete pre-anesthetic blood work (Mini Chemistry/CBC for patients less than 8 years of
age and a Full Chemistry/CBC for patients over 8 years of age), and/or any other procedures specified
for this animal. I acknowledge understanding of the risks and benefits of the planned procedure(s) and have had the opportunity to have any questions I may have about the procedure(s) addressed. I understand there are certain inherent risks with anesthesia and surgery, which may include complications resulting in illness or death. I authorize the use of the anesthesia agent(s) of your choice to support the well-being of the animal and any emergency procedures that may be required in the course of rendering treatment.










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