Consent To Surgery

This form provides your formal consent for your pet to undergo surgery at Concierge Veterinary Hospital. Your thorough and accurate responses help us ensure the safest and most appropriate care for your pet.

First Name

Last Name

Phone Number

Email Address

Address

Name

DOB

Sex

Type of Animal

Color

Breed

Is the pet pregnant?

Describe Surgical Procedure

Medical Conditions

Current Medications

Today's Date

Initials

By submitting this form, I confirm that I am the legal owner or authorized agent of the pet listed below. I consent to the recommended surgical procedure and understand that all medical and anesthetic procedures carry inherent risks. I acknowledge that the veterinary team will take all reasonable precautions and may perform necessary treatments to ensure my pet’s safety and well-being.

Consent to Surgery

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