Surgery

Surgical Consent Form

Owner's Name







Address


















FOR ALL PROCEDURES:

Homeagain Microchip


If you select NO, please enter your initials to acknowledge.
Nail Trim


If you select NO, please enter your initials to acknowledge.
Ear Cleaning


If you select NO, please enter your initials to acknowledge.
Anal Glands


If you select NO, please enter your initials to acknowledge.
My pet is current on heartworm prevention and has not missed any doses


If you select NO, please enter your initials to acknowledge.

CONSENT

Signer Name







FOR DENTAL PROCEDURES:

I want my pet to have any loose or infected teeth extracted while my pet is under anesthesia. I understand that extractions are an additional cost.

Call first before doing any extractions. If I cannot be reached, nothing will be done.

No, I do not want my pet to have any loose or infected teeth extracted while my pet is under anesthesia. I understand the risks if these teeth are not extracted.