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Surgery Consent Form

Fill out our new client from before your visit with us!

fill out our forms today!

Surgery Consent Form

Fill out our new client from before your visit with us!

Surgery Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Pet Information

Pet's Name *

Contact Information

Owner's Name *

First

Last

Email *

Phone *

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is: (example: lump removal, exam, etc.) *

Additional Services Desired While Patient Is Sedated

Please select any/all that you would like us to provide while your pet is sedated

Implant Microchip
Nail Trim
Vaccination
Heartworm
FeLV/ FIV Test
Other (specify below)

Please specify where the lumps are located *

Please specify the additional service(s) you'd like provided to your pet *

Additional Comments/ Concerns

Authorization

I authorize anesthesia/sedation for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with anesthesia and/or sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. *

I have read, understand, and authorize

I authorize Care-Pets Animal Hospital to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical complications or otherwise unforseen circumstances. I understand there are rare complications associated with any anesthetic procedure. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures. I fully understand these risks and understand the veterinarians and hospital staff will try to minimize such risks. I will not hold Care-Pets Animal Hospital, the veterinarians, or any staff member liable for any complications that may arise. *

I have read, understand, and authorize

Payment due upon services rendered. *

I have read, understand, and agree.

I HAVE READ AND FULLY UNDERSTAND THIS ANESTHESIA CONSENT FORM *

Yes

Signature of Responsible Party *

Clear Signature

Date *

Comment

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Ready for a visit?

If you live in Clark or Floyd County, just north of Louisville, and need trusted veterinary care for your pets – look no further. At Care-Pets Animal Hospital and Wellness Center, your pets are our pets! Easily book an appointment for your pet using our online system.

Book Appointment

Have a question?

Complete our online form, and a member of our team will be in touch with you shortly.

Address

8800 Old State Rd 60, Sellersburg, IN 47172

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Contact

E: info@carepetsah.com
Call or Text: 812-246-6146

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Hours

Monday – Friday: 8am – 12pm | 2pm – 6pm
Saturday: 8am – 12pm
Sunday: Closed

Name *

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Last

Email *

Phone

How can we help you? *

Email

Holiday Hours

We are closed on New Years Day, Memorial Day, Fourth of July, Labor Day, Thanksgiving Day and Christmas Day.

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