Anicare Consent Form

CONSENT FOR TREATMENT

1. "PET" has been fasted for the past 12 hours. Yes___ No___ Initials___
2. I am the owner of the animal identified above. I am 18 years of age or older and I have the authority to give this authorization and do so voluntarily, having been advised of all probable and material risks associated with this treatment.
3. The procedures identified above have been described to me, and the purpose for performing them and the risks involved with them have been explained to my satisfaction. I realize that there can be no guarantee as to my animal's condition or the outcome of any procedures. In particular, I have been advised that, in the event that the treatment requires the use of anaesthesia, there is a risk of death every time an anaesthetic is used and I have been advised of the likelihood of such occurrence.
4. I authorize the performance of the identified procedures and the use of associated anaesthetics and other medications.
5. I also understand that unforeseen conditions may be revealed during the identified procedures that, in the opinion of the attending veterinarian, may require more extensive or different procedures or treatments. I understand that reasonable efforts will be made to contact me to explain these procedures or treatments and obtain instructions regarding them. However, if the efforts are unsuccessful, I authorize the performance of any procedures or treatments that are necessary in the professional opinion of the attending veterinarian.
6. If spaying today and "PET" is found to be pregnant at the time of the surgery, do you wish us to continue with the surgery? Yes____ No____ Initials______
7. If doing dental work today, do you give permission for any necessary extractions? Yes____ No____ Initials_____

Estimate:
Surgery: $___________
Other: $___________
Microchip: ($60.50) Yes_____ No______

8. I agree to pay $_____ for the above procedures and related clinic fees. I will pay this money at the time the animal is discharged and hereby acknowledge my indebtedness for this amount.
9. I have read and understand this authorization.

Signed_________________________________ Print name__________________________
Contact Number: ___________________________
Alternate Number: _________________________

Location & Hours

Location & Hours

Anicare
2263 Mt.Newton Cross Road
Central Saanich, BC V8M 1T8
(250) 652-5505 (250) 652-5548 Fax

Hours
Mon-Fri 8.30am to 5:30pm
Sat 9:00am to 12:00pm

After hour emergencies : 250-475-2495 Central Victoria Veterinary Hospital  www.centralvictoriavet.com