Surgery/Dental Consent Form

Name*

First NameLast Name

Pet's Name*

Pet's Name

Email*

example@example.com

Phone Number where you can be reached the day of the procedure*

Area CodePhone Number

Date of Procedure

Date

Type of procedure

Your pet should be fasted (not given food) after 9pm the night before the procedure. Water is OK and should not be restricted

Yes, I undertand and have fasted my pet

Are there any health concerns with your pet that you would like our veterinary team to address? (ear infection, lameness, etc)

Would you like your pet microchipped at the time of the procedure?

Yes, please microchip my petNo, do not microchip my pet

What to expect on the Day of the Procedure

Please drop off your pet between 8am - 830am.
Your pet will be greeted by one of our veterinary nurses. This nurse will be responsible for your pet's care and comfort for the entire day.
A doctor will complete a throrough physical exam and perform preanesthetic bloodwork prior to the procedure.
The order of procedures will be triaged that morning, with the most critical patients creceiving intervention earlier in the day.

Every patient receiving general anesthesia will have an IV catheter and IV fluids to maintain IV access, blood pressure and hydration.

During the anesthetic procedure, your pet's nurse will be monitoring blood pressure, pulse oximetry (oygen levels), ECG (heart rate and beat), and temperature.

The doctor will call you when your pet is in anesthetic recovery and provide you with a summary of the procedure and when your pet will be discharged.

I have received an estimate for the procedure and understand that payment is due at the time of service.*

Yes, I received an estimate for the procedureNo, I have not received an estimate for the procedure

By signing below, I certify that I am the owner or agent of the owner of the above named pet and I have the authority to make medical decisions related to the pet. I authorize the Devon Veterinary Staff to provide care and perform any treatment they consider reasonable and necessary for my pet.

I understand that payment in full is required at the time of service. DVH will provide an estimate of fees upon my request. I acknowledge that an estimate is only an approximation; actual fees may vary. I recognize that I am responsible for all charges related to my pet.

I understand that risks exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure in initiated.

Signature*

Clear

Surgical/Dental Consent Form