• Authorization to Perform Procedure Form

    This form is optimized for mobile use, and requires a digital signature.  It is best completed with a handheld device.
  • Please take a few moments to read through the following information and answer the appropriate questions so that we may best care for your pet. PLEASE NOTE: If you have more than one pet scheduled, this form will need to be completed for EACH pet.
  • Appointment Information

  •  - -
    Pick a Date
  • Microchip Information

  • Westchase Veterinary Center Policies Policies

    Please initial below each policy that you have read and agree.
  • PET's health questionnaire

    Please initial or answer the following questions as appropriate
  • If any medications listed above are daily please contact the clinic for further instructions.

  • Emergency Order

  • In the event of an unforseen emergency, we will attempt to reach you without delay.  Please know that we take every precaution to ensure PET is safe and healthy enough to undergo PROCEDURE.  Any known risks have been discussed with you.  However, very rarely, medical emergencies do happen and we want to know your preference on how you would like for us to proceed.  Please choose an option below. 

  • Verification of Ownership and Procedure Authorization

  • I verify that I am the owner (or duly authorized agent for the owner) of the PET and authorize PROCEDURE to be performed by Westchase Veterinary Center.  I authorize the use of anesthesia and other medications deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure as directed by the veterinarian. 

    I have been advised as to the nature of this procedure to be performed and the risks involved.  No guarantees have been made regarding the outcome or cure.  I understand that there is always a risk associated with any anesthesia episode, even in apparently healthy animals, and have discussed my concerns with the veterinarian.  The veterinarian has provided me the opportunity to ask questions and receive answers regarding the procedure.  This risk includes bodily injury or death.  I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of PET.  I hereby consent to and authorize the performace of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgment.  I accept responsibility for any result in additional charges. 

    I agree to be responsible for all charges incurred while PET is in the care of this facility and understand payment is due at the time my pet is released from the hospital.  PET will receive pain medication prior to and after any procedure, treatment or surgery when pain or discomfort is anticipated or expected.

  • Clear
  • Please contact us to schedule your pet's appointment.

    You are receiving this message because you selected that your pet does not already have an appointment scheduled for a procedure. Please contact us for further help.
  • To contact us:

    Phone: 813-818-0087

    Text: 813-818-0087

    Email: info@westchasevet.com

    website: www.westchasevet.com

  • To contact us:

    Phone: 813-818-0087

    Text: 813-818-0087

    Email: westchasevet@gmail.com

    website: www.westchasevet.com

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