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Your Name

Pet's name

Phone

Email

Would you like us to call or text you with questions or when your pet is ready to go home?

Call
Text

Alternate contact person

Alternate phone number

Please indicate the date of your pet's procedure.

Please check all surgical procedures that you are consenting to have performed on your pet.

If you are having any other procedures preformed, please specify.

Have you or your pet been exposed to or tested positive for COVID-19 in the last 2 weeks?

Please explain if you chose yes.

Please explain if you checked any symptoms above.

Please list any medications, supplements, topical treatments your pet will receive or take 24 hours before surgery. Please note if they will be given the night before or morning of surgery.

Please list your pet's heartworm, flea, and tick preventative(s) with date last given or applied.

What diet/food do you feed your pet and how much?

Authorizations

Authorizations

I certify that I am the owner of the above-named animal or am responsible for it and have authority to execute this consent. I hereby authorize the performance of the above procedure(s) or treatments by McKinney Animal Hospital doctors and staff. The nature of the procedure(s) has been explained to me and no guarantee has been made as to the results or cure. I understand that there is a risk involved with the administration of anesthesia, up to and including death. I have been encouraged to discuss any concerns I have about the risks involved with the attending veterinarian before the procedures are initiated. Should life-saving emergency care be required and the attending veterinarian is unable to reach me, the staff has my permission to provide such treatment and I agree to pay for such care. I agree to indemnify and hold you harmless from and against any and all liability arising out of the performance of the procedures referred to above and below

I understand.

I understand that to help avoid or detect problems which may prove that anesthesia would be detrimental for my pet, my pet will be screened by means of a Pre-Anesthetic blood panel if it has not been performed within the last 30 days.

I understand.

I understand that an intravenous (IV) catheter will be placed to allow for administration of fluids and/or medications during the anesthetic/surgical/dental procedure. (A small area of hair will be shaved in order to place the catheter).

I understand.

I understand that pain relief medication will be administered to my pet to minimize postoperative pain and discomfort. Pain medications are administered in injection form prior to most surgical procedures. In some instances a post operative pain or anti-inflammatory injection may be given to help minimize pain and/or inflammation. Post operative pain medication in tablet, pill, or liquid form will be dispensed to continue at home.

I accept.

I have had the opportunity to ask questions and those questions have been answered to may satisfaction.

I accept.

I have read and accept the above stated terms.

I accept.

Today's Date