Standard Consent Form

MICROCHIP to return lost pets
A microchip is now available to return your pet to you quickly and safely in the event he/she runs away. It’s the size of a grain of rice and is inserted under the skin. It causes no discomfort and remains active for the life of your pet. If your pet accidentally gets away and is taken to a shelter or animal hospital, a scanner will pick up the microchip’s number for your pet and you will be called immediately.

The cost is $45.00 for the chip, this includes lifetime registration.

I have received an estimate of the cost for the following procedure

If not, I want an estimate before the procedure is done.

I hereby authorize performance of the following surgical or other procedure(s)

MM slash DD slash YYYY

I understand that during the performance of the foregoing procedure(s) or operations(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) in addition to those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operations(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgement.

I also authorize the use of appropriate anesthetics and other medications, and I understand that the hospital support personnel will be employed as deemed necessary by the veterinarian.

The nature of such service has been described to me to my satisfaction and I realize that no guarantee or
warranty can ethically or professionally be made regarding the results or cure.

I understand I assume financial responsibility for all services rendered, and that payment is due on the
date of procedure.

MM slash DD slash YYYY


Our greatest concern is the well-being of your pet, especially during anesthesia. Our well-trained staff use state-of-the-art
monitoring equipment and the safest anesthetic available. These precautions help to make our anesthesia very safe for the healthy
pet. Prior to anesthesia, our staff will obtain a complete history of your pet, and the veterinarian will perform a complete physical
examination. This provides us with vital information about your pet’s health. However, it is impossible to understand the
complete physiological picture without performing blood tests. The blood tests we recommend are like, and equally as important,
as those your own physician would run if you were to go under anesthesia.

It is important to understand performing these tests does not guarantee complications will not occur. They are important in
minimizing the risk of anesthesia, and they provide you and us with peace of mind. They may also identify a medical condition
that is not apparent by physical examination alone.

In some cases, abnormal blood tests will cause us to delay a surgical procedure and attempt to diagnose the medical problem
causing the abnormal tests. In many instances, these values will help us determine which pre-medication agents to use for your
pet’s safety and the need for additional medications after surgery. We can alter standard protocols based on your pet’s particular
values. If tests are normal, we can proceed with a greater degree of confidence, and we will have established an excellent set of
baseline values to use and compare should your pet become ill in the future.

If your pet has NOT had pre-operative bloodwork already, we strongly recommend one of the
  1. (recommended for all ages; REQUIRED for animals ages 8+ or with pre-existing conditions) ($260.00): Most complete bloodwork panel, giving full chemistry values, red
    & white blood count (CBC), thyroid, electrolytes & more. MUST BE SCHEDULED 48+ HRS
  2. Pre-Op Lab Screening w/ Clotting (appropriate for animals up to age 7, with no pre-existing
    conditions)($120.00): All the information from the Complete Chemistry Panel below plus CBC &
  3. Complete Chemistry Panel Plus ($220.00): A complete chemistry panel to fully evaluate
    internal organs, red blood cells & blood electrolytes. COMPLETED DAY OF PROCEDURE
  4. Mini Chemistry Panel Plus ($155.00): Basic values for evaluating the liver, kidneys, blood
    sugar, red blood cells and protein levels. COMPLETED DAY OF PROCEDURE
Select your Bloodwork

MM slash DD slash YYYY

PLEASE NOTE: Additional panels may be required prior to surgery, regardless of your pet’s age,
based on your pet’s health history & at the doctor’s discretion.

MM slash DD slash YYYY