Hospitalization/Surgery/Anesthesia Authorization Form

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  • Procedure Consent

  • I am the owner of the above named animal or am responsible for it and have the authority to execute this consent form.

    I hereby authorize Animal Health & Medical Center to perform such diagnostic, therapeutic, anesthetic and surgical procedures as are necessary and advisable for the treatment and maintenance of my pet’s health.

    • While I expect all procedures to be done to the best of the abilities of the professional staff, I realize that no guarantee or warranty can ethically or professionally be made regarding the result or cure.
    • In the event that my animal should, for some unforeseen reason, injure itself, escape, fail to eat, become ill or die, I will not hold Animal Health & Medical Center and/or its employees responsible.
    • I expect that reasonable precautions will be used to insure the animal’s safety and well-being while in the clinic’s care and agree to pay in full for all services and products at the time of discharge.
    • If unforeseen needs arise that have not been discussed and I cannot be reached for approval, I accept the doctors’ decision to proceed with that which is necessary.

    By agreeing below, I also give my permission and agree to pay for parasite control to be administered if my pet is found to be carrying any parasites (including fleas, ticks or ear mites).

  • Optional Additional Services (Additional Cost)

  • Lasts 24 hours after the surgery.
  • This screening is not a guarantee against problems or complications, but it will help us deal with a problem, should it arise, or avoid the procedure altogether until a discovered problem can be corrected.

  • Check all services you'd like rendered. (NOTE: Your pet's vaccinations must be current, or be done at time of services)
  • This field is for validation purposes and should be left unchanged.