Surgery Consent Form

Save time during your next appointment! Complete your surgery consent form online from any device at any time before your visit.

Surgery Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

Current medications: (Please specify the name of the medication and the amount given)

Pre-Anesthetic Blood Work

Pre-anesthetic blood work is important for an internal exam that can determine white and red blood cell counts,platelet counts, blood sugar, electrolyte levels, kidney and liver values. Help us provide the best level of carefor your pet by choosing to perform blood work prior to anesthesia or sedation.
  • There will be an additional charge for animals that are in heat or pregnant and are undergoing spay/neuter surgery.
  • All patients undergoing anesthesia will have an intravenous catheter placed to allow the administration of anesthetic agents and facilitate emergency treatment if necessary (Note: an area of hair will be clipped on a front limb to accommodate catheter placement).
  • Any medications to be dispensed will be determined by the nurse and doctor at the time of surgery and you will be responsible for any charges.


I understand that unforeseen conditions may be found or arise in performing the above-listedprocedure(s)/operation(s) and that extended or (a) different procedure(s)/operation(s) may be required. In thatevent, I understand the veterinarian will attempt to call me at the Primary Contact Phone Number above thatI provided and will leave a message with the details of the extended or different procedure(s)/operation(s); if Iam unreachable or do not return the call within 10 minutes, I consent to and authorize RAH to perform allprocedure(s)/operation(s) with the veterinarian deems necessary in his/her professional judgment. I alsounderstand that my pet will be undergoing general anesthesia and this does not come without risk ofanesthetic reactions such as (but not limited to): hives, sudden drop in blood pressure, or death in rare cases.

I have read and understand this authorization.

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