SurgeryConsent Form

For a smoother process at Grace Animal Hospital, please fill out the form below as completely and as accurately as possible.

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Surgery Consent Form

Name *

First

Last

Email *

Pet's Name *

Phone number at which owner can be reached: *

Additional Number: *

When was the last time pet was fed? *

Would you like us to text you after the procedure, or would you prefer a call?

Text
Call

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. * *

I have read and agree.

Please type your initials *

Date *

Grace Animal Hospital

SurgeryConsent Form

Surgery Consent Form

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