Surgery and Treatment Consent
Owner's name
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First Name
Last Name
Email
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example@example.com
Pet's name
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Procedure
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When did your pet last eat, prior to surgery?
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What medications is your pet currently taking?
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When did your pet last receive the medication, prior to surgery?
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Pre-anesthetic blood testing allows us to screen for underlying liver and kidney disease, diabetes, anemia and dehydration in young apparently healthy patients. (Testing is required for pets 7 years and older.)Would you like us to run pre-anesthetic bloodwork for an additional fee?
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Yes
No
Already performed
When was the bloodwork performed?
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-
Month
-
Day
Year
Date
A microchip is a form of identification that allows your pet to be identified even if his/her collar is removed. We can quickly and painlessly insert a microchip under your animal’s skin while he/she is under anesthesia.Would you like us to place a microchip in your pet today for an additional fee?
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Yes
No
Already has a chip
An IV catheter will allow open access in case of an emergency, and will also enable a smoother recovery.Will you allow us to place an IV catheter in your pet for an additional fee?
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Yes
No
I understand that it may be necessary for the veterinarian to contact me while my pet is under anesthesia. I will be available that day at:
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Please enter a valid phone number.
This number can be used for
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Voice
Text
Do you want to add a secondary contact number?
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Yes
No
Secondary contact name
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First Name
Last Name
Secondary phone number
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Please enter a valid phone number.
This number can be used for
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Voice
Text
Please initial below each paragraph to indicate your acknowledgement of our policies and procedures.
I certify that I am the owner, or authorized agent of the owner, of the above named animal and have the authority to authorize treatment. I do hereby consent and authorize Animal Hospital of Ovilla and its staff to hospitalize my pet to perform the above procedure(s). I understand that some risk of adverse effects always exists with anesthesia and medical and surgical treatments. Adverse effects may include, but are not limited to, infection, neurologic disease, cardiovascular disorders, metabolic disease, disfigurement and, rarely, death. I also understand that no specific result is guaranteed. I further authorize the hospital staff to provide emergency procedures deemed necessary by the veterinarian for the well-being of my pet.
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I understand if fleas are found on my pet, they will be treated at my expense.
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I understand that all fees for my animal’s care will be due in full at the time of discharge.
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If I cannot be reached at the listed phone number to authorize other treatment, please proceed in the best interest of my pet. I understand that there may be additional charges.
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Signature (use finger, stylus, or mouse)
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Submit
Should be Empty: