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Surgery & Anesthesia Consent Form

Thank you for choosing Cottage Pet Hospital. Please fill out the following form before your scheduled appointment with us!

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Surgery & Anesthesia Consent Form

Please fill out the following form as thoroughly as possible so we can better serve your pet. If you have any questions, please feel free to give us a call at 714-535-6714. Please download and fill out our Surgical Information Packet and bring it with you when you drop off your pet. We look forward to seeing you and your pet!

If you would prefer to download our form to fill out at home, please use one of the buttons below.

Surgical Packet

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Name *

First

Last

Email *

Pet's Name *

Pet's Age *

Procedure Your Pet Is Receiving *

Anything else needed while pet is under anesthesia?

Emergency Phone Number *

I consent to receive SMS text messages from Cottage Pet Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

While undergoing these procedures your pet will receive anesthetic drugs that prevent pain. Because we care about your pet’s comfort and strongly believe that pain relief is important, additional pain medications will be provided, as needed, to control the level of your pet’s discomfort after surgery and during its recovery.

I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics and other medications, as well as any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read, and fully understand, this consent. *

I have read and understand

The fees associated with these services have been explained to me, and I agree to pay such fees at the time my pet is released from the hospital. *

I have read and agree

Signature *

Clear Signature

Today's Date *

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Online Forms

Surgery & Anesthesia Consent Form

Surgery & Anesthesia Consent Form

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