Consent form

We are here to keep your pet safe and healthy.

We look forward to treating your pet.

We take every precaution when sedating or anesthetizing our patients. We are honored that you trust us with the safety and well-being of your pet.

Anesthesia/Surgery Consent Form

Please fill out the following form as thoroughly as possible before your scheduled procedure day. Please Note: all * fields are required.

Client Name *

First

Last

Email *

Patient Name *

Phone number at which owner can be reached today or tomorrow: *

Additional phone number you can be reached at:

Before Procedure:

Would you like to be contacted before your pet goes in for the procedure? *

Would you like to be contacted by text or phone call before the procedure? *

Text
Call
Either

If text, what number would you like to be texted at?

After procedure:

Would you like us to text you after the procedure, or would you prefer a call? *

Text
Call

Anesthetic and surgical procedure(s) to be performed: *

I, the undersigned owner or agent of the pet identified above, authorize the staff of Alma Vet Connection to perform the above procedure(s). *

I have read and agree.

Microchip: *There is an additional fee for this procedure* *

Yes
No
My pet already has one.

Have you given your pets any medications or supplements in the past week? *

Please specify and note last time medication was given:

When was the last time your pet was fed?

Any other concerns/allergies/procedures?

I understand that some risks always exist with anesthesia and/ or surgery. I also understand that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. *

I have read and agree.

I am over 18 years of age and understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life-sustaining procedures. *

Yes, I give my permission.
No, I do not give my permission.

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow-up radiographs, re-check physical exams, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. *

I have read and agree.

Signature *

Date *

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Your preferred Wellington veterinary hospital

When you bring your pet to our veterinary clinic in Wellington, FL, you’re trusting their health and care
to the very best the Wellington area has to offer.



Location

11320 Fortune Cir, Ste G1-G2
Wellington, FL 33414

Contact Us

P: 561-345-2537
F: 561-409-5769
E: [email protected]

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Hours

Monday - Friday
8:00 AM - 5:00 PM

Contact Us

Because if we can’t resist the looks your pets give us, why should you?

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Email *

Phone

How can we help you? *

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