Surgery & Anesthesia Consent Form

If your pet has to undergo surgery or anesthesia, please fill out the form below.

male veterinary surgeon performing surgery on dog

Surgery & Anesthesia Consent Form
Client Name
Client Name
First Name
Last Name
Would you like a text notification when your pet is out of surgery?
I hereby authorize Van Crest Animal Hospital, and its designated associates to perform the above procedure(s). In addition, in the event that emergency treatment is required and I cannot be reached, I agree to any necessary diagnostic, treatment, or surgical procedures that are required.
In order to maintain a healthy, clean, hospital environment, pets must be free of parasites (fleas, ticks) and be current on vaccinations. If necessary, pets will be updated on vaccinations and treated for any fleas or ticks at an additional charge.

Additional Optional Services (Please mark if you approve any of these additional services)

Pre-Surgical Blood Screening: To identify potential health risks we recommend a more comprehensive blood testing, a CBC (complete blood count), indicates anemia, infection, or other cell related problems. Also included in the package is a blood chemistry to evaluate the liver and kidneys, as well as diabetes (this testing is required on all patients over 6 years of age). The cost is an additional $85.00. Includes: BUN (kidneys) ALKP (Liver) CBC (Complete Blood Count) Glucose (Blood Sugar) Total Protein (Hydration) PVC (O2 Saturation) ALT (Liver) Creatinine (Kidney)
Microchip Identification: Prepare for disaster. Very few pets find their way home without permanent identification. We can implant a MICROCHIP while the pet is sedated for $53.00.
Other optional procedures that may be done at less cost since the pet is already sedated include (check if wanted)
**EVEN WITH ALL PRECAUTIONS, ANY TIME AN ANESTHETIC AGENT IS GIVEN OR SURGERY IS PERFORMED, THERE IS ALWAYS THE POSSIBILITY OF LOSS OF LIFE.**
I have read and understand this consent form, and I agree to pay for services rendered at the time my pet is discharged or when service is otherwise completed.