Surgical Consent Form

With any anesthetic or surgical procedure, there is an inherent amount of risks involved. We strive to reduce as many risks as possible to ensure a safe recovery for your pet. This is done in part by giving your pet the utmost care and monitoring during given procedure. We also perform a routine physical exam as part of our pre-anesthetic screening.

Procedure(s) to be done today:(Required)

PRE-SURGICAL BLOODWORK

Pets Six Years or Younger: $267.30
Pre-Anesthetic profile PCV (Packed Cell Volume) and TP (Total Protein)

Pets Seven Years or Older: $312.10
CBC (Complete Blood Count) and Complete Diagnostic Panel

Like you, our greatest concern is the well-being of your pet. We HIGHLY recommend that the pre-surgical blood profile be performed to maximize patient safety and alert the doctor of any health problems that could complicate the procedure.

Authorize Pre-Surgical Testing(Required)

I AUTHORIZE Eastgate Animal Clinic to perform any necessary laboratory testing.

I DECLINE all laboratory testing. I fully understand the possible consequences of anesthesia/surgery being performed without the knowledge obtained from the recommended bloodwork.

PRE-SURGICAL bloodwork was done prior to surgery within the last 30 days.

***Would you like to have your pet Microchipped while they are here? (Price: $52.79)(Required)

Yes

Owner/Authorized Agent Name:(Required)

First Last

Owner/Authorized Agent Email:(Required)

For copy of this form for your records.

Today's Date:(Required)

Please provide phone number where you can be reached TODAY.(Required)

Secondary Phone:

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