Pre-Operative Consent Form

Pre Operative Consent Form
At Advanced Veterinary Care, we are dedicated to providing high quality surgery and medicine to your special family member. We will be happy to provide you with an estimate, if requested.

* Indicates required field

Pet's Name *

First

Last

Species *

Color *

Age/Birthday *

Date *

List all allergies to medications *

List any food allergies *

List any known medical conditions or concerns *

List any medications that your pet has taken in the last 2 weeks including supplements and over the counter products such as aspirin *

Would you like us to place a microchip in your pet while they are sedated? The cost is $88 *

Growth Removal (indicate site/location) *

Other Procedure *

As the owner/agent of the above pet, I authorize to execute this consent *

I understand the risks of both surgery and anesthesia (including death) *

I authorize consent to perform the above indicated procedure(s) *

Owner/Agent electronic signature *

Date of consent *

Good contact number *

Submit