Ghent and Granby Veterinary Consent: Surgery

Ghent and Granby Vet Hospital - Surgery Forms

Please review and sign these forms for your pet's upcoming procedure. If you have any questions, please call/text 757-351-0167 or email welcome@ghentandgranby.com
Your first and last name*
Your pet's name*
Type of pet*
Are you interested in a medical pet shirt to aid in your pet's recovery?

YesNo
See below for example pictures of medical pet shirts for dogs and cats. These can aid in recovery for pets whose procedures affect a body area covered by the shirt (e.g., spay, neuter, mass removal, abdominal exploratory). The typical price for a medical pet shirt is $40. The medical staff will assist with any questions you may have.
Procedure Date*

MonthDayYear
Date
Please select from the following

I would like to come inside the hospital when dropping off and picking up my pet.I prefer curbside service when dropping off and picking up my pet.
Signature - Consent #1 of 3*

I hereby authorize Ghent and Granby Veterinary Hospital to perform the surgery listed on this estimate. I acknowledge that I am the owner/appointed caregiver of the animal described above. I understand that surgery poses a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver, I understand that by signing this Estimate, I agree to pay for all charges +/- 15% of the fees as shown on this Estimate and will pay the balance in full upon discharge. The surgery and relevant costs have been fully explained to me to my satisfaction.
Signature - Consent #2 of 3*

I hereby authorize Ghent and Granby Veterinary Hospital to use general anesthesia on my pet for the above treatment/surgery listed on this estimate. I understand that anesthesia poses a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver, I understand that by signing this Estimate, I agree to pay for all charges +/- 15% of the fees as shown on this Estimate and will pay the balance in full upon discharge. The anesthesia and relevant costs have been fully explained to me to my satisfaction.
Consent #3 of 3*

MICROCHIP: Please microchip my pet today.FECAL FLOAT: please perform a fecal float and evaluation for intestinal parasites.HEARTWORM/EHRLICHIA/LYME/ANAPLASMA: please screen my dog for Heartworm, Ehrlichia canis, lyme, and Anaplasmosis.TOE NAIL TRIM: please trim my pet's nails.VACCINATIONS: please update my pet's vaccinations based on his/her lifestyle.NONE OF THE ABOVE
Please select today's date
Primary Phone Number to be reached during procedure*

Area CodePhone Number
Secondary Phone Number to be reached during procedure

Area CodePhone Number
Alternate Contact and Phone Number
Anything additional you would like to share?
Please note that this procedure is scheduled at our Granby Vet location (3415 Granby St. in Norfolk)
Should be Empty:

Ghent and Granby Vet Hospital - Surgery Forms

Please note that this procedure is scheduled at our Granby Vet location (3415 Granby St. in Norfolk)