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Authorization and Consent to Anesthesia for Surgery and/or Diagnostic/Therapeutic Procedures

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I am the owner or agent for the above-named animal, I have the authority to execute this consent, and I agree to the terms outlined below.

  • Pet must be current on vaccines and intestinal parasite screening or they will be performed/administered at the owner's expense.

  • Pet must have recent laboratory tests on file, or have them performed today. These tests assist in tailoring specific anesthetic agents for your pet and increasing safety.

  • Pain management will be part of most surgeries/procedures and is not optional. The veterinarian will work with you to pick the safest and most convenient medications.


Laser Surgery


Ancillary Procedures

Microchip ($57.50), Nail Trim (N/C), Ear Cleaning (N/C), Cold Laser Therapy ($27), Express Anal Glands ($28.90)


In an emergency, we will make all attempts to contact you at the listed emergency number. However, I authorize the clinic staff to follow through with such procedures as are necessary for the well being of my pet on a continuing basis until further communicating with me. I understand that I assume all financial responsibility for all routine and emergency services rendered.


I hereby authorize the clinic to perform such diagnostic, therapeutic, and surgical procedures as described above. The nature of such services has been described to me to my satisfaction, and I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure.