Surgery Consent Form

Name: The Pet Hospital
Address: 501 E Virginia Ave, Bessemer City, NC, 28016, United States
Telephone: 704-629-5390
Price range: $

Please fill out the form as completely as accurately as possible.

Get Started

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. If this is an emergency, or if your pet needs urgent care, please call us at 704-629-5390 for a faster response.

Section A - to be completed for all SURGICAL procedures

Owner's name *

First

Last

Email *

Phone Number *

Pet's name *

Surgery date *

Procedure *

Emergency contact phone number *

Section B - Please review and accept or decline these OPTIONAL services

Can we do pre-anesthetic blood testing? ($143.00 | $182.00 for pets over the age of 7) *

The Pet Hospital recommends pre-anesthesia blood testing to check for disorders of the liver, kidneys and blood. This blood test is not a guarantee against the risks of anesthesia, but will identify most conditions that can hinder recovery or even cause the death of your pet. We STRONGLY recommend for pets over 7 years of age.

Is your pet here for a dental procedure? (Starts at $260.00) *

Once the doctor begins the dental cleaning, he/she may discover tooth decay beneath the gum line. If so, it would be a danger to your pet's health and it may be necessary to do extractions. Are you ok with extractions?

May we administer IV fluids? ($79.00 - only included if getting dental) *

Pets that are very small or females that are pregnant, we STRONGLY recommend fluids.

Pain Management is required for all patients under going surgery. *

I understand this is required.

While undergoing surgery and after, your pet will receive a pain injection. In most cases the injection will not have lasting effects. Additional pain medication can effectively control your pets discomfort while recovering at home.

Do you want an E-Collar? ($21.00) *

Some pets will naturally tend to "lick their wounds" to ease discomfort. If your pet licks too much, the incision site can become infected, which will require antibiotics to heal- *CONE*

HomeAgain Microchip ($44.00) *

Inserted while under sedation. There is an additional form to be completed at checkout.

Nail trim ($11.00) *

Nail trims are easier on pet while under sedation (reg. price $25.00)

Section C - to be completed for all anesthetized procedures

I, being responsible for the above animal, have the authority to grant you my consent to receive treatment, prescribe for and/or operate upon my pet as noted above. You are to use all responsible precautions against injury, escape, or death of my pet, but you will not be held liable or responsible in any matter, as I thoroughly understand and assume all risks. I agree to pay in full for all services rendered at the time of discharge.

Owner's signature *

Date *

Book an Appointent

We can't wait to meet you! We proudly serve the pets of Bessemer City, NC and beyond. Download our PetDesk app to access your pet’s medical records, receive automatic reminders, and more!

Book Appointment Download App