Procedure Consent Form

Pet Species *


PLEASE READ THE FOLLOWING INFORMATION CAREFULLY, AND INDICATE YOUR CONSENT AT THE BOTTOM OF THIS SECTION.



 

  • 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 treatment plan.
     
  • I also understand that unforeseen conditions may be revealed during the above procedures, which in the opinion of the Veterinarian require more extensive or different procedures or treatment. I understand that reasonable efforts will be made to contact me to explain these procedures and/or treatments and obtain my instructions regarding them. However, if the efforts 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 Veterinarian in whose care I hereby place.
     
  • 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 that 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 *
If your pet is not microchipped, would you like one administered while they're here today? ($135.00 plus tax) *
Would you like us to perform therapy laser post surgery? This promotes healing and reduces inflammation ($31.00 plus tax) *
Would you like to go home with probiotics (Forti Flora SA)? This reduce chances of soft stool from anesthesia/ medication (10 days worth, $16.73 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 *
Security Question *