Healthy Start Spay/Neuter Consent

OWNER INFORMATION

Full Name *

Pet's Name *

Address *

City *

Province *

Postal Code *

Email Address *

It is imperative that we be able to reach you in a timely manner while your pet is in the building today. Please have your cell phone listed below and be free to talk.

**If your pet is diabetic or on heart medication please bring the insulin/medication with you to your pet's appointment. Fast as instructed**

ACKNOWLEDGMENTS

I understand that all additional elective procedures such as hernia repair, dewclaw removal etc. will NOT be included in the price of a spay/neuter and will need to be discussed with/authorized by the surgeon before hand. *

I verify that I am the owner (or authorized agent for the owner) of the above named pet and I authorize treatment of my pet to be performed by Central Animal Hospital. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure as directed by the veterinarian. *

I have been advised as to the nature of this procedure to be performed and the risks involved. No guarantees have been made regarding the outcome or cure. I understand that there is always a risk associated with any sedation or anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. The veterinarian has provided me the opportunity to ask questions and receive answers regarding the procedure. This risk includes serious bodily injury or death. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian's professional judgement. I accept responsibility for any result in additional charges. *

I agree to be responsible for all charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. In the unlikely event my pet may need to stay overnight I understand no staff will be attending to my pet between the hours of 10 pm and 6 am (pets needing special care may be referred to a 24 hour hospital). *

In the event of an unforeseen emergency, we will attempt to reach you without delay. Please know that we will take every precaution to ensure that your pet is safe and healthy enough to undergo their procedures today. Any known risks will be discussed with you. However, very rarely emergencies do happen, and we want to know your preference if no one can be reached. Please check your preference: *

Please DO proceed with life-saving measures. I will accept all responsibility for all costs incurred.
Please DO NOT proceed with life-saving measures. I accept responsibility for all costs incurred.

I am aware that due to possible unforeseen emergencies, patients will be triaged resulting in my pet being in the care of Central Animal Hospital until later in the day than expected. *

I understand that there are inherent risks with sedation and that a guarantee of a successful outcome cannot be made. These risks have been explained to me as completely as possible within reason. I also understand that Central Animal Hospital will do their best to minimize these risks through pre-anesthetic blood testing, and using the most appropriate and safest anesthetic procedures and monitoring available. Furthermore, I agree to pay the fees for all services rendered at the time my pet is discharged from the hospital. Please sign recognizing that you have read and understand the risks. *

Signature *

Date *

Today

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

Healthy Start Spay/Neuter Consent

OWNER INFORMATION

PET INFORMATION

ACKNOWLEDGMENTS