Feline Surgical Consent Form
Client's Name*
First Name Last Name
Email*
example@example.com
Phone number where you can be reached day of surgery.*
Area Code Phone Number
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Pet's Name*
Breed*
Sex*
Color*
Surgical procedure(s) to be performed:*
When was food last given?*
I, the undersgned owner or agent of the pet identified above, authrorize the staff of SAH to perferm the above procdures.
I understand that some risk always exists with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedures(s) is/are initiated.
In case of unforeseen emergencies, the staff may or may not have my permission to proceed with life sustaining procedures?*
Yes I give my permission and understand I am responsible for the cost of these procedures. No I do not give my permission.
Would you like your cat FELV/FIV tested? Cost $42.35*
Yes No Already tested Please vaccinate my cat for Felv if the test is negative.
Has your cat been dewormed in the last 6 months?*
Yes No No, Please deworm today.
If your cat has ear mites upon exam today would you like us to treat your cat in clinic today?*
Yes No
Has your cat had any previous surgeries?*
No Spay/Neuter Dental
Has your cat shown any signs of illness in the last 2 weeks? If, yes please explain*
Is your cat currently taking medications? If yes, then please list the medications including dosage*
Like you, our greatest concern is the well-being of your pet. Sedation and anesthesia can involve risk to your pet. For this reason we highly recommend and request your permission to perform a Blood Profile & CBC to assist in the evaluation of your pet's ability to utilize and metablize the anesthetic medications(s) that will be used during this procedure.
** Pets REQUIRED to have a Blood Profile & CBC, will include;**
Any pet 7 years of age or older
Any pet in poor body condition or found to have abnormal physical exam determined by the doctor to potentially place your pet at a higher risk while under anesthesia.
Blood Profile & CBC*
I authorize SAH to perform the necessary surgery to pet. Yes, please do the recommended Blood Profile & CBC. No, (my pet is less than 7 years of age) I do not authorize the recommend Blood Profile & CBC. I understand the risk and complications if I do not follow the instructions given to me after the procedure which involves post-treatment and follow-ups. I release SAH for any responsibility in case of an accident, illness, or injury.
Surgical Laser aids in healing time, blood loss, and less attention to the surgical site by your pet. This option is available for an additional charge, on some procedures. Additional laser fee runs between $57.75-$86.75, please inquire about the additional cost based on today procedure.
Surgical Laser*
Yes, pleaseuse the surgical laser for today procedure provided the doctor see fit to doso. No, do not usethe surgical laser for today procedure.
Pain associated with surgery is 100% predictable. Therefore go home pain medications will be prescribed as the doctor sees fit with today procedure. A Therapy Laser Treatment can dramatically reduce pain and swelling. It can also fast forward the healing process. The cost of a Therapy Laser Treatment is $10.25
Pain Control Therapy Laser Treatment*
Yes, Please perform a Therapy Laser Treatment after my pet's procedure today provided the doctor sees fit to do so. Do not preform a Therapy Laser Treatment.
A microchip can be inserted under the skin between the shoulder blades to aid in recovery and identification of a lost or stolen pet. The cost is $36.75 and that includes the lifetime registration of the chip. The information needed for you to register your pet will be sent home with your pet.
Microchip*
Yes, Please insert a microchip while my pet is asleep. No, I do not want my pet microchipped today. My pet is already microchipped, please check my pet's chip today.
While your pet stays with us we require him/her to be up to date on vaccinations and to be free of external parasites such as fleas or ticks. If your pet is found to be unvaccinated or if fleas or ticks are found the proper vaccines/medications will be given at the owner's expense.
Vaccinations, Fleas/Tick Control*
Yes, my pet is up to date on vaccinations, and flea/tick control No, my pet is not up to date on vaccinations and I understand they will be updated today at my expense. No, my pet is not current on flea control and I under that if external parasites are found my pet will be treated at my expense.
I have read this entire consent form. While I accept that all procedures will be performed to the best of the abilities of the hospital staff, I understand that no guarantee or warranty has been made reguarding the results that may be achieved.
Owner Release*
Yes, I assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as progress exams, radiographs and/or additional surgery due to post-op complications.
Client/Agent Signature*
Clear
Should be Empty:

Feline Surgical Consent Form