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Surgical & Anesthetic Consent Form

Name: Advanced Veterinary Medical Center
Address: 30470 Grand River Ave, Farmington Hills, MI, 48336, United States
Telephone: 248-478-5400
Price range: $

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Surgical & Anesthetic 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 248-478-5400 for a faster response.

Client Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Pet's Name *

Species *

Dog
Cat
Other

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Anesthetic and medical or surgical procedure(s) to be performed today: *

I, the undersigned owner or agent of the pet identified above, certify that I am eighteen years of age or over and authorize the veterinarian(s) at Advanced Veterinary Medical Center to perform the above procedure(s). I understand that some risks always exist with anesthesia and/or surgery. I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

The reasonable medical and/or surgical treatment options for my pet
Sufficient details of the procedures to understand what will be performed
How fully my pet will recover and how long it will take
The most common and serious complications
The length and type of follow-up care and home restraint required
The estimate of the fees for all services
Any necessary payment arrangments

While I accept that all procedures will be performed to the best of the abilities of the staff at Advanced Veterinary Medical Center, I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved. I assume financial responsibility for all fees and provide payment via cash, credit card, or check at the time my pet is discharged from the hospital. Should unexpected life-saving emergency care be required and the staff is unable to reach me, the staff has my permission to provide such treatment, and I agree to pay for such services. *

I have read and agree.

I accept that veterinary medicine is not an exact science and that no guarantee of successful treatment has been made. I have read and understand the nature of the above procedures and give my consent to proceed. *

I have read and agree.

Signature *

Clear Signature

Date *

Surgical & Anesthetic Consent Form

Surgical & Anesthetic Consent Form

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