Consent for Surgery

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Consent for Surgery

So that we can prepare for your cat’s procedure, please complete and submit this form at least 48 hours before your scheduled appointment.

Printable Version

Name *

First

Last

Email *

Phone *

Cat's Name *

Procedure(s) Being Performed: *

Description of Services

Your cat will be undergoing general anesthesia today for the surgical procedure listed above. During general anesthesia, your cat is completely unaware of his/her surroundings and is not responsive to external stimuli. For your cat’s comfort and safety, he/she will receive oxygen and anesthetic gas through a breathing tube and receive fluids and medications through an intravenous (IV) catheter. *

I have read and understand.

Please read the following statements, then sign below.

I have been advised of the nature of the services and procedures included in the Treatment Plan, as well as the risks involved. While I expect all procedures to be performed to the best of the staff’s abilities, I realize that medical results cannot be guaranteed. *

I have read and agree

I understand that, although uncommon, complications can occur with any surgical procedure, including but not limited to the possibility of infection, bleeding, blood clots, swelling, and bruising. Additional complications for this specific procedure have been discussed with me. *

I have read and understand

I understand that abiding by the post-operative instructions is crucial for a proper recovery and to help avoid postoperative complications. *

I have read and understand

I have reviewed and approved the Treatment Plan presented to me. I understand that a deposit of 100% of the lower end of the estimate is due when my cat is admitted to the hospital, and that the remainder of the invoice is due in full at discharge. *

I have read and agree

I understand that during anesthesia, surgery, or recovery, unforeseen conditions may be revealed that necessitate an extension of the procedure, or even procedures different than those set forth in the Treatment Plan. I understand that the estimate may not be a complete representation of my final bill if additional procedures are performed. *

I have read and understand

I acknowledge that I have read this form, that I understand the risks, alternatives, and expected results of the surgical procedure, and that I had ample time to ask questions and to consider my decisions. *

I have read and agree

Signature *

Date *

Consent for Surgery

Consent for Surgery

Description of Services

Please read the following statements, then sign below.

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