Surgery Consent Form

Surgery Consent

Client

Client ID

Client

Name

First Name

Last Name

Address

City

State

Zip Code

Phone

Patient

Patient ID

Name

Species

Sex

Color

Markings

Birth Date

Weight (lb)

Authorization

Date

I hereby certify that I am the owner of the above-named animal or am responsible for it and have the authority to execute this consent. I hereby authorize the performance of the following procedure(s): I hereby also authorize the use of such anesthetics as you deem advisable and performance of such surgical or therapeutic procedures as you determine to be indicated. I agree to indemnify and hold South County Animal Hospital harmless from and against any and all liability arising out of the performance of any of the procedures referred to above. Pre-Anesthetic blood work is required for all surgical procedures. Any patient that does not have current blood work (within 1 month) will have this service performed prior to any procedure requiring sedation and/or anesthesia.

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Surgery Consent Form

Client

Patient

Authorization

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