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If you would like to attach any medical records you have for your pet, please do so here.
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY, AND INDICATE YOUR CONSENT AT THE BOTTOM OF THIS SECTION.
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*: