Surgical Consent Form

Patient Information:

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Owner's Name:

Procedure Information:

Date and Time of Procedure:

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Time
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Description of Procedure:

Risks and Benefits:

I, the undersigned owner or authorized agent, understand that no surgery is without risk, and I have been informed of the potential risks and benefits associated with the proposed procedure. The veterinarian has explained the nature of the procedure, including any alternative treatments, and has answered all of my questions to my satisfaction.

Consent for Anesthesia:

I understand that anesthesia will be used during the procedure. The risks associated with anesthesia, including but not limited to allergic reactions, respiratory distress, and cardiac arrest, have been explained to me, and I consent to the administration of anesthesia.

Consent for Blood Work:

I understand that pre-anesthetic blood work may be recommended to assess the overall health of my pet and detect any underlying conditions that may affect the safety of the procedure. I consent to the performance of blood work as recommended by the veterinarian.

Consent for Pain Management:

I understand that pain management is an integral part of the surgical process, and I consent to the administration of pain medications as deemed necessary by the veterinarian.

Financial Responsibility:

I understand that I am financially responsible for all charges associated with the surgical procedure. An estimate of charges has been provided, and I agree to make payment in full at the time of service.

Emergency Care Authorization:

In the event of a medical emergency or complication, I authorize Symphony Mobile Veterinary Clinic to provide any necessary and reasonable medical treatment for my pet.

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Thank you for entrusting Symphony Mobile Veterinary Clinic with the care of your pet. If you have any further questions or concerns, please feel free to discuss them with the veterinarian before signing this consent form.