Surgery Consent Form

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Surgery Consent Form

Please complete the form before your visit. We will get in touch with you if we have any questions.

I, the undersigned, do hereby certify that I am the owner (or a duly authorized agent for the owner) of the pet named above. I consent and authorize Robertson County Animal Clinic (RCAC) to hospitalize, administer vaccines, medications, and anesthetics; and perform tests and surgical procedures that the doctors deem necessary for the health, safety, and well-being of the patient while at RCAC.

 

The nature of the treatments and procedures has been explained to my satisfaction. I realize that no guarantee can ethically or professionally be made regarding the results, cure, or outcome.

 

I understand that I, the undersigned, assume financial responsibility for all services rendered and that payment in full is due at the time services are performed.

 

Should I not pay in full and my account becomes delinquent, I also understand that I am responsible for any collection fees incurred.

Medical History
Pre-Anesthetic Bloodwork
Intravenous Catheter and Fluids
Antibiotics
Pain & Anxiety Medications
Laser Therapy (Photobiomodulation) – Not Used on Growth Removals
Microchip
Elizabethan Collar
Growth & Tumor Removals