Surgery & Anaesthesia Consent Form

This form provides essential information related to your pet’s upcoming surgical procedure and anaesthesia. Completing it in advance helps ensure clear communication, safety, and preparedness on the day of surgery.

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Before Your Pet’s Procedure

Surgery & Anaesthesia Consent

This form must be completed before your pet’s scheduled surgical procedure. It outlines consent, potential risks, and important information related to anaesthesia and surgery to support your pet’s safety and comfort.

Contact Information

Owner's Name *

First

Last

Email *

Phone *

Pet Information

Pet's Name *

Pre-Surgery Information

Is your pet taking any medications or supplements that we would not be aware of?

Do you have any new concerns for your pet?

Authorization

If anaesthesia/sedation is required, I understand that there are risks involved and that in the event of an emergency, the hospital will take all necessary actions to control the problem and will notify me as soon as possible. I understand and agree to the use of human medicine in my animal when deemed appropriate by the veterinarian.

I have read, understand, and agree

I can be contacted via text message for updates on my pet's status.

I have received an estimate for my pet's procedure.

I fully understand that this is an estimate only. West Niagara Animal Hospital makes every effort to remain within the estimate given. I agree to meet the costs of all treatment at the time of discharge. I understand the risks and complications of these procedures, which have been explained to me by the veterinarian. *

I have read, understand, and agree

All accounts are payable at the time of consultation unless a prior arrangement has been made.

Signature of Owner or Agent *

Clear Signature

Today's Date *

Name

Surgery & Anaesthesia Consent Form

Before Your Pet’s Procedure

Surgery & Anaesthesia Consent

Contact Information

Pet Information

Pre-Surgery Information

Authorization

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Caring Veterinary Services in Lincoln, ON

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