• Anesthesia Consent & Informed Surgical Consent form

    Thank you for choosing Highland Veterinary Clinic. We're here to provide compassionate, innovative, excellent care. Your pet is scheduled for an anesthetic related procedure, dental cleaning, or surgical procedure. We strive to provide excellence in surgical and nursing communications, but we understand that procedures involving surgery or anesthesia can create stress on pet owners. To communicate effectively, and ensure that your pet's admission process is as low-stress as possible for you and your pet, we created a required online informed anesthesia consent and surgical admission form which will allow for you to focus on your pet during admissions day. We require this form to be completed, signed and on file prior to admitting your pet for any anesthetic related procedure.

  • We will attach a copy of these responses to your pet's record and can provide a printed copy at your request. Admission time on surgery day is 7:30-8:30am on the day your pet is scheduled. Alternatively, we can schedule one free pre-admission boarding night at no cost to you if surgery is completed the following day.

     

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  • Is this number text/SMS enabled?*
  • Confirm Surgical Appt Date
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  • PATIENT INFORMATION & HEALTH STATUS

  • Patient Species*
  • Confirm Pet's Biological Gender & Reproductive Status*
  • I understand that state law requires rabies vaccination for all pets. If my pet’s protection against rabies virus is current at another facility, it is my responsibility to provide this documentation from another facility. If I am unable to provide documentation, I grant Highland Veterinary Clinic with permission to confirm this information by telephone or fax from another facility. I understand that if my pet's rabies vaccination is not current, state law requires that the clinic administer the vaccination, and it must be given at my expense. I further have been informed, that clinic policy recommends that distemper/parvovirus vaccination & vaccination against infectious tracheobronchitis for dogs and/or feline panleukopenia (distemper) vaccine for cats be kept current. I have been informed as to the risk of these illnesses, that these illnesses may cause morbidity and/or death. I release Highland Veterinary Clinic, its owners, doctors, and staff from all liability should my pet contract any of the aforementioned diseases.*
  • Date*
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  • Procedural Consent & Financial Responsibility

  • My patient's primary authorized surgical procedure:*

  • If the patient’s condition warrants it, I would like these elective procedures to be completed at the same time for an additional fee:

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  • I understand that during the performance of the foregoing procedure(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s), or operation(s), or different procedure(s) or operation(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the attending veterinarian or surgeon’s professional judgment.

     

  • I also authorize the use of appropriate anesthetics, and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I understand that in the interest of humane treatment, pain medication is now considered essential for some procedures, and is dispensed at the veterinarian’s discretion.

     

  • I have been advised as to the nature of the procedures or operations and the risks involved. I realize that results cannot be guaranteed.  I also assume financial responsibility for all charges incurred to the patient, and agree to pay all such charges at the time of release of the patient.

    I further understand that In the event of nonpayment, fraudulent payment, bounced checks, or any violation of any prior agreed payment arrangement, the entire balance shall be considered in default with the addition of any and all banking, collection fees, collection agency and/or attorney fees, necessary to the amount due to Highland Veterinary Clinic without any relief whatever from Valuation and Appraisement Laws. I further understand that my check may be presented electronically at any time for validation or deposit.

  • Date of Signature*
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  • Should be Empty: