Veterinary Surgery Consent and Authorization Form

Surgery Consent Form

Pet Information

Pet's Name *

Pet Type * Choose... Cat Dog Bird Other

Sex * Choose... Male Female Neutered Male Spayed Female

Species *

Breed *

Date of Birth *

Age *

Weight (kg) *

Micro Chip Number *

Owner Information

Owner's Name *

Phone *

Secondary Contact Name

Secondary Contact Phone

Procedure

Today's Procedure *

Authorization

I authorize anesthesia/sedation for my pet. I understand the risks involved.

I authorize necessary treatments or procedures for unforeseen circumstances.

Payment is due upon services rendered.

Doctor's Name *

Doctor's Signature *

Owner's Signature *

Date *