Surgical Consent Form

Owners Name *

First Name Last Name

Phone number where you can be reached during the scheduled surgical procedure: *

Patient Name *

First Name Last Name

What procedure(s) is your pet coming in for? *

Please select the elective services you would like performed:

Pre-anesthetic Laboratory Evaluation: $132 (patients under 7 years old) $155 (patients over 7 years old) *Bloodwork is required for all patients over 7 years old or at the doctors discretion when deemed necessary.* I.V. Catheter and I.V. Fluids: $53 (Required for all patients over 7 years old or at the doctor's discretion if deemed necessary.) Home Again Microchip: $55 Surgical Laser: $55-$83 Using the surgical laser has proven benefits such as: less post-op pain, less swelling, less bleeding, and quicker recovery. Canine Heartworm Test: $42 (Heartworm testing should be done annually for all dogs over 1 year of age.) Intestinal Parasite Screening: $27 (Intestinal parasite screening should be done annually for all pets.) Nail Trim: $18

Does your pet have any allergies? *

Yes No Not Sure

If yes, please tell us below what allergies your pet may have.

Is your pet currently taking any medications? *

Yes No

If yes, please tell us below what medications your pet is taking and when the last dose was given:

All surgical patients must be up to date on vaccines. If your pet is past due for vaccines we will give the required vaccines at the time of thier surgical procedure.

Vaccine Requirements:

Canine - Rabies, DHPP, Bordetella

Feline - Rabies, FVRCP, Bordetella

I hereby authorize anesthesia/surgery for my pet. I understand that some risks always exist with anesthesia and/or surgery. My signature on this consent form indicates that any questions have been answered to my satisfaction. While Hog Mountain Animal Hospital provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. In particular, I have been advised that there is an extremely small risk of death, complications, or side effects every time an anesthetic is used and that I have been advised of the possibility. I acknowledge these risks and understand that the veterinarians and hospital staff will try to minimize such risks. I will not hold Hog Mountain Animal Hospital, the veterinarians, or any staff member liable for any Complications that may arise. Please select yes to indicate that you understand and agree with the above information. *

Yes No

By signing below you give Hog Mountain Animal Hospital consent to perform the above procedures and treatments. *

Clear

Anesthesia & Surgical Consent Form