• Surgical Consent Form

    Companion Animal Clinic
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  • At Companion Animal Clinic we strive to practice quality medicine. Human hospitals require laboratory testing before anesthetic procedures. To proceed in the safest manner possible, we STRONGLY RECOMMEND that pets are also properly screened. The results of laboratory blood screening can warn us about underlying conditions that could lead to complications. We are especially concerned with the kidney and liver functions as these are the primary organs that metabolize anesthetic drugs. The complete blood count is also important as this can identify underlying infections, anemia or clotting problems. Please indicate whether you accept or decline this service.
    *Please note that any patients age 5 or over are required to have this blood panel done prior to anesthesia.*

  • If parasites (fleas, ticks, ear mites, intestinal parasites, etc.) are found on your pet we will treat at the owner’s expense for the protection of your pet and others.


    Clients who are having their female pet spayed should be aware that if she is pregnant, the puppies or kittens will be aborted during the surgery. There is an additional charge for spaying a pregnant animal or an animal that is in heat.


    If your puppy or kitten has persistent (baby) teeth that have not fallen out on their own, they will be removed for a fee of $7.50 per tooth. (Failure to extract these teeth will cause excessive tartar and overcrowding of adult teeth.)


    Though complications are rare, there is inherent risk in surgery and general anesthesia and sedation. Companion Animal Clinic cannot be held responsible for any reactions your pet may have to these medications.

    By signing below you are giving consent to the staff and veterinarians of Companion Animal Clinic to anesthetize and perform the previously listed procedures (unless specifically declined) and acknowledge that you understand the special notes explained. By signing below you also agree to indemnify and hold the staff and veterinarians of Companion Animal Clinic free from and against any and all liability that may arise out of the performance of any of the procedures referred to above.

    By signing below you certify that you are the owner or authorized agent for the above named animal and that you are responsible for him/her and have the authority to execute this consent.


    By signing below you agree that you are responsible for payment in full of all above mentioned procedures and treatments at the time the patient is discharged.

    We will make every effort to reach you should questions or problems arise, however, by signing this form you authorize the doctor to treat your pet as deemed necessary should he/she be unable to contact you at the number(s) provided. You also understand that veterinary staff will not be on premises 24 hours a day.

    If you miss this appointment without calling Companion Animal Clinic to inform them ahead of time, you will be charged a $25.00 deposit if you want to schedule another appointment. That $25.00 will be deducted from your invoice balance on the day of the new appointment. If you miss the new appointment without letting CAC know ahead of time, the deposit is nonrefundable.

    I have read and understand ALL of the above information.

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