SURGERY ADMISSION FORM

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