WOAHVETS - Surgery / Procedure Consent Form

White Oak Animal Hospital
Surgery/Procedure Consent Form - Canine

Date

Owner’s Name

Pet’s Name

Phone Number:

Routine Procedures

Spay

Neuter

Dental

Other Procedure / Treatments:

Dentals Only:
Do we have your permission to extract teeth? Yes No

Preliminary / Pre-Anesthetic Bloodwork

Pre-Surgical Screen:
For any procedure!!!!

This screens for medical problems that cannot be seen with a physical exam.

***This test is highly recommended for pets having sedation!

Accept Decline

Surgical LASER:

The Laser is used in place of the scalpel blade.

*** Laser surgery helps to reduce pain, reduce blood loss and reduce the chance of infection.

Accept Decline

Heartworm Test:
Over 6 months of age!!!!

Heartworms are transmitted by the bite of a mosquito.

***Heartworm disease can cause complications during anesthesia or sedation.

Accept Decline

Home Again Would you like your pet to be Microchipped while under anesthesia?

Accept Decline

I hereby authorize and direct the veterinarians of White Oak Animal Hospital to perform the above procedures as deemed advisable or necessary for my pet. The nature of the procedure(s) has been explained to me and no guarantee has been made as to the results or cures. I understand that there may be a risk involved in these procedures and all questions have been answered to my satisfaction.

Discharge Appointment:

Pre-Surgical Screen: For any procedure!!!!	This screens for medical problems that cannot be seen with a physical exam. *This test is highly recommended for pets having sedation! Accept Decline**
Surgical LASER:	The Laser is used in place of the scalpel blade. * Laser surgery helps to reduce pain, reduce blood loss and reduce the chance of infection. Accept Decline**
Heartworm Test: Over 6 months of age!!!!	Heartworms are transmitted by the bite of a mosquito. *Heartworm disease can cause complications during anesthesia or sedation. Accept Decline**
Home Again	Would you like your pet to be Microchipped while under anesthesia? *Accept Decline*
I hereby authorize and direct the veterinarians of White Oak Animal Hospital to perform the above procedures as deemed advisable or necessary for my pet. The nature of the procedure(s) has been explained to me and no guarantee has been made as to the results or cures. I understand that there may be a risk involved in these procedures and all questions have been answered to my satisfaction.
Discharge Appointment: