• ABOUT US
    • Meet Our Doctors
    • Meet Our Reception Staff
    • Meet Our Technicians
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      • Wellness Visits
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  • PATIENT FORMS
    • New Client Questionnaire
    • Medical History Form
    • Surgery Admission Form
    • Dental Admission Form
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  • FREE VACCINES FOR LIFE
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  • BILL PAY
  • CONTACT US
  • EMERGENCY
  • ABOUT US
    • Meet Our Doctors
    • Meet Our Reception Staff
    • Meet Our Technicians
    • Meet Our Support Staff
    • Our Services
      • Wellness Visits
      • Surgical Services
      • Dental Services
      • Radiology Services
      • Therapeutic Laser
      • Pharmacy Services
      • Laboratory Services
  • PATIENT FORMS
    • New Client Questionnaire
    • Medical History Form
    • Surgery Admission Form
    • Dental Admission Form
    • Ultrasound Admission Form
  • FOR PATIENTS
    • Puppy Tips and Care
    • Kitten Tips and Care
    • Specialty Services
    • Veterinary Care Foundation
    • Useful Links
  • FREE VACCINES FOR LIFE
  • SHOP
    • Food and Pharmacy
    • Merchandise
  • BILL PAY
  • CONTACT US
  • EMERGENCY

SURGERY ADMISSION FORM


Does your pet have a microchip?

Would you like your pet to have a Home Again Microchip implanted?

Has there been any change in your pet’s condition since your last appointment?

Does your pet have allergies

Choose
Choose
Choose
Choose

I verify I am the owner (or Authorized agent for the owner) of the above named pet and authorize the above procedure to be performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. 

I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always risk associated with any anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. While I understand that all available precautions are taken, I also understand that risks and potential complications exist with anesthesia and with surgery. These include, but are not limited to: abnormal reaction to anesthetic agents, organ failure, obstructed airway, regurgitation, aspiration of vomitus, nerve damage, post-operative infection and potential death. 

I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgment. I accept responsibility for any result in additional charges. 

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 

256 Cherry Street, Milford, CT 06460 • 203-876-0943 (fax) • info@mahct.com • PHONE or TEXT: 203-878-7471

HOSPITAL HOURS:
Monday-Friday: 8:00 am - 5:30 pm • Every Other Saturday: 8:00 am - Noon (Wellness Only) • Sunday: Closed
For a current listing of Open Saturdays, click here.


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