Authorization For Anesthesia/Surgery Logo
  • Authorization for Anesthesia and/or Surgery

  • I authorize the veterinarian(s) at Animal Medical Center of Corona to perform the above procedure(s). I understand there are risks associated with anesthesia and/or surgery. I am encouraged to discuss any concerns I have regarding those risks with the attending veterinarian before the procedure(s) are initiated.

    My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

    • The reasonable medical and/or surgical treatment options for my pet
    • Enough details of the procedures, to understand what will be performed
    • How my pet will recover and how long it will take
    • The most common and serious complications
    • The length and type of follow-up care and home restraint required (will go over in more detail at the time of release)
    • The estimate of the fees for all services

    Regarding the surgical procedure(s), I understand there is no guarantee or warranty associated with the achieved results.

    I agree to pay a deposit of 100% of the low end on the estimated fees and assume financial responsibility for the remaining fees. Payment options available are via cash, credit card, Care Credit, All Pet Card, or Scratch Pay. All charges must be paid in full at the time of my pet’s discharge from the hospital.

  • Should unexpected life-saving emergency care be required, and the hospital staff is unable to reach me, I   *   *   ,   *   the staff to provide the emergency treatment and/or to resuscitate. Depending on the authorization, I agree to pay for said services.

  • I certify that I am over the age of 18 and legally competent to sign this form. I understand that this document constitutes a legally binding contract. I have completely read, understand, and voluntarily accept the terms of this agreement. 

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