Owners's Name *

First

Last

Email *

Phone

Pet's Name *

Age or DOB *

Gender *

Male
Neutered Male
Female
Spayed Female

Species *

Cat
Dog
Other

If other, please specify *

Is your pet current on vaccinations? *

Yes
No

Has your pet eaten today? *

Yes
No

Procedures to be performed: (Type of surgery)

I understand that my pet is here today to have a surgical procedure performed. I, the undersigned owner or agent of the pet identified above, authorize the staff of Pet Vet Hospital and Wellness Center to perform the above procedure(s). *

I agree

I understand that anesthesia carries certain risks, including but not limited to allergic reactions, adverse effects on vital organs, and, in rare cases, death. I acknowledge that the veterinarian has explained these risks to me, and I have had the opportunity to ask questions and address any concerns.

I authorize the veterinarian and veterinary staff to administer anesthesia to my pet and to perform any necessary procedures or treatments deemed appropriate during the anesthesia period. I understand that the veterinary team will monitor my pet closely throughout the procedure to ensure its safety and well-being.

I understand that anesthesia carries certain risks, including but not limited to allergic reactions, adverse effects on vital organs, and in rare cases, death. I acknowledge that the veterinarian has explained these risks to me and I have had the opportunity to ask questions and address any concerns. I authorize the veterinarian and veterinary staff to administer anesthesia to my pet and to perform any necessary procedures or treatments deemed appropriate during the anesthesia period. I understand that the veterinary team will monitor my pet closely throughout the procedure to ensure their safety and well-being. *

I agree

CPR/DNR

In medical practice, unforeseen emergencies may necessitate immediate treatment without the veterinarian having time to confer with the owner. Thus, we request your preference regarding CPR and emergency life-saving procedures for your pet before departure. Please choose one option below.

CPR/DNR In medical practice, unforeseen emergencies may necessitate immediate treatment without the veterinarian having time to confer with the owner. Thus, we request your preference regarding CPR and emergency life-saving procedures for your pet before departure. Please choose one option below. *

CPR: If necessary, I wish for the veterinarian to perform CPR on my pet and to initiate any other necessary life saving measures while trying to contact me. I agree to be responsible for the costs of such measures and understand that these measures may lead to costs greater than the estimate given.
DNR: I do not wish for the veterinarian to perform CPR on my pet in the event of an emergency.

I acknowledge that I have been provided with an estimated cost for the procedure(s) listed above. I accept financial responsibility for the recommended services. I understand and agree that payment is due at the time services are rendered. I have read and fully understand the terms and conditions outlined above. *

I agree

Date *

Pet Vet Hospital and Wellness Center Surgery Release Form

Surgery Release Form

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