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Procedure Consent Form

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If you would like to attach any medical records you have for your pet, please do so here.
Pet Species*:


The nature, purpose, and effect(s) of this/these operation(s) and/or procedure(s), as well as the attendant risks and alternatives, have been clearly and adequately explained to me.

I understand that there can be no guarantee as to the animal’s condition or the outcome of any procedure and/or treatment.

I understand that there is always risk inherent to anesthesia. The following precautionary measures have been recommended: fasting, intravenous fluids and pre-surgical blood work; and I have accepted or declined them as stated on the attached treatment plan.

I understand that unforeseen conditions may be revealed during the above procedures, which 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 and/or treatments and obtain my instructions regarding them prior to proceeding. If the efforts to reach me are unsuccessful, I consent to such further operation(s) and/or procedure(s). I understand that I am responsible for all charges incurred.

I consent to the assistance of other hospital personnel at the Veterinarian’s direction, considered necessary or advisable by the attending Veterinarian, in whose care I hereby place my pet.

I understand that Wellesley Animal Hospital is not staffed overnight.

I understand that if my pet(s) should be found to have fleas or other external infectious parasites that s/he will be treated at my cost.


I understand that if I should leave my animal(s) for more than 3 days, or their belongings for more than 30 days, that they shall be considered abandoned and will become the property of Wellesley Animal Hospital.

I certify that I have read, have interpreted and fully understand the above, and give my consent for the procedure(s) detailed in the attached treatment plan*:
Would you prefer a regular e-collar, a soft cone, or a surgical onesie for your pet to wear home?*:

If your pet is not microchipped, would you like one administered while they're here today? ($64.11 plus tax)*:

Would you like us to perform therapy laser post surgery? This promotes healing and reduces inflammation. ($29.32 plus tax) *Not applicable to dental procedures or feline neuters* :

Would you like to go home with probiotics (Forti Flora Pro)? This reduce chances of soft stool from anesthesia/ medication (10 days worth, $13.50 plus tax)*:

The following questions apply to dental procedures only, please select N/A if not applicable.


I prefer to be called before any extractions/treatments are performed* :

If I cannot be reached, I authorize you to proceed with all necessary dental procedures regardless of cost*:

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