Treatment Consent

1152 Stonecrest Boulevard

Tega Cay, SC 29708

(803) 547-8387

www.baxtervet.com

Anesthesia/Surgery Consent Form

Client Name*

Patient Name*

As the owner or agent of the above pet, I hereby give my consent to Baxter Veterinary Clinic to perform the following procedure(s) and understand that anesthesia or sedation may be necessary.

Procedure(s) Requested*

When did your pet eat last?*

I understand that during the performance of this procedure(s), unforeseen conditions may be revealed that necessitate a change of procedure or additional procedures. I expect the staff at Baxter Veterinary Clinic to use reasonable care and judgement in performing the procedure(s). The nature of the procedure(s) and the risks have been explained to me, and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any financial obligation incurred regarding my pet.

Current Medications:

Refills Needed:

YesNo

In the event of an emergency:*

I do authorize CPR or other life saving procedures in the event of an emergency.I do NOT authorize CPR or other life saving procedures in the event of an emergency.

Microchip:*

I would like my pet microchipped today with a HomeAgain microchip. (The enrollment is paid for by the clinic).I would NOT like my pet microchipped today with a HomeAgain microchip. (The enrollment is paid for by the clinic).

Therapeutic Laser Treatment*

I would like my pet to receive therapeutic laser treatment to assist healing following the procedure.I would NOT like my pet to receive therapeutic laser treatment to assist healing following the procedure.

Electronic Signature*

My signature above verifies that I am at least 18 years of age and am financially responsible for this pet. With this siganture, I agree to the terms and services discussed on this consent form.)

Best contact name and number:*

You will be notified by text message when your pet is out of surgery.