GBarN Veterinary Clinic Surgery Consent Form
 
Date______________ Phone (Where you can be reached today)___________________
* Veterinary services during night and/or weekends are provided at the discretion of the veterinarian in charge. Continuous presence of personnel may not be provided during these hours.*
 
As the owner or agent of the above animal, I hereby give my consent to G-N Veterinary Clinic to perform the following procedures:
 
Ovariohysterectomy                   Declaw 2 feet                       Dental Cleaning                     
Castration                                   Declaw 4 feet                       Tail dock                                
Microchip implantation              Other (specify)__________________________________
 
I understand that during the performance of this procedure unforeseen circumstances may occur that may necessitate a variance in the procedure above. I expect G-N Veterinary Clinic to use reasonable care and judgment in performing the procedure(s). The nature of the procedure(s) and risks involved has been explained to me and I realize the results can not be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding the animal.
 
            _________________________________
            Owner/Agent
 
*All animals admitted must be free of external parasites. Any animal found to have fleas or ticks will be treated at the owner’s expense.*
 
PRE-ANESTHESIA REQUEST
If your pet is anesthetized, rest assured that advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications. Never the less, occasional problems can arise due to preexisting conditions not evident during preanesthetic physical examination. To avoid these problems, we recommend a blood screening prior to all anesthetic procedures (screening is optional). Please initial your choice below.
 
______ A.I refuse preanesthetic screening.
______ B.Preanesthetic mini screen $57.35
______ C.Preanesthetic screen (CBC/Chem12) $182.50
______ D. Panel (required for animals over 7 years old)(CBC/Thyroid/Chem 12) $212.50