PRE-SURGICAL CONSENT FORM

PRE-SURGICAL CONSENT FORM
Pet Name
Procedure(s)
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.
Pre-Anesthetic Bloodwork Options (Choose ONE)
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
CAPSTAR REQUIRED FOR ANY CAT WITH LIVE FLEAS $12.70
ADDITIONAL PROCEDURES, Select any you would like done
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 ONLY: CHOOSE ONE OPTION
Owner Name
Signature
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number to reach while pet is here:
Format: (000) 000-0000.
Last time my cat ate-Best Estimate (please let front staff know at check in what time the patient last ate):
In the unlikely event of an emergency, I prefer (CHOOSE ONE):
Should be Empty: