PRE-SURGICAL CONSENT FORM

Pet Name: blanks* is scheduled for blank* .

Our greatest concern is the health and well-being of your pet. They will receive a pre-anesthetic exam at no charge. Their vital signs will be monitored throughout the procedure, and they will be provided heat support. Some cats have underlying health conditions we cannot evaluate without a blood screen. We REQUIRE bloodwork for all anesthetic procedures except spays and neuters. Bloodwork is recommended for all animals.

Please list any known health problems, if none, put N/A

Please list ALL medications and supplements your cat is currently taking as this may affect our anesthetic protocols. If none, put N/A

Additional Procedures:

CapStar is required for ANY cat with LIVE FLEAS ($12.70)

E-COLLARS (Cones) ARE NOT INCLUDED. Would you like to purchase one?

If YES to purchasing an e-collar, which type would you like?

I realize and accept there is risk with general anesthesia and Cat Care Hospital will provide the best care possible for your pet. I certify that I have read and fully understand the above authorization form and the listed procedures are correct.

For dental procedures: CHOOSE ONE OPTION

Owner Name (PRINT)

Signature

Date:

Date

Phone Numbers:

Format: (000) 000-0000.

Last time my cat ate:

In the unlikely event of an emergency, I prefer (choose one):