Patient Admission Client Consent Form – Surgery


Thank you for entrusting us with your pet’s care. It’s a responsibility we take seriously, and we ask that you please take a moment to review and provide the following information below.

This information is required prior to any exams or procedures for your pet. If you have any questions, please feel free to ask!


"*" indicates required fields

Please select the location you will be visiting*

Owner and Pet Information

Owner Name*
Please describe in your own words to the best of your ability.
Please note that if fleas are found on your pet today, they will be treated at your expense.
I certify that I am the owner of the patient or agent of the client and have the authority to execute this consent.*
Please fill in your Full Name as acknowledgement

General Instructions

If your pet is having sedation or anesthesia, do not feed your pet past midnight the night before the procedure.

In general, it is okay to allow access to water overnight, but pick up your pet's water dish in the morning.

If your pet takes medicine, CHECK WITH YOUR VET about whether or not you should administer the dose on the morning of the procedure.

If your pet is coming in for diagnostic testing (such as blood work or an ultrasound) please do not feed on the morning of the test unless your vet instructs you otherwise.  If in doubt, CHECK WITH YOUR VET

Please Read and Initial Each of the Four Statements Below.

Procedure Consent

Should my pet experience life-threatening complications under anesthesia, I understand the staff will make all reasonable efforts to reach me.  If I cannot be reached, I DO / I DO NOT authorize the staff of Companion Pet Hospital to perform CPR procedures and accept the charges associated with these treatments.*
Dental Procedure Patients: Diseased or damaged teeth may be found during the anesthetized oral exam or on X-rays that were unexpected. In the event that extractions are necessary and we are unable to contact you, please choose one of the following:*
Patients receiving sedation or anesthesia will go home with detailed home care instructions.  In general, you will want to have a quiet and secluded place for your pet to rest and recover. Please indicate if you have any of the following concerns (check all that apply):*
Would you like your pet to have a pedicure performed today for an additional charge?*
A HomeAgain Microchip is a form of permanent identification that can be used to help ensure your pet’s safe return in the event that they become lost. Would you like a microchip to be placed today?*
Please note that the $85 Microchip & Registration fee is waived for pets under the Puppy/Kitten Package.
This field is for validation purposes and should be left unchanged.