We’re Hiring! Join Our Team Today! Click Here to Learn More

Surgery Consent Form 

green hand-drawn divider

Fill out this form prior to your pet’s surgery with us at New Richmond Veterinary Clinic.

New Richmond Surgery Consent Form 

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

We will need to be able to contact you or someone with permission to make medical and financial decisions.

We will need to be able to contact you or someone with permission to make medical and financial decisions.

Please note: If your pet has fleas, they will be given a Capstar at your expense.

In order for our doctors to do a complete analysis for diagnosis; do we have permission to perform the following if needed?

 

Please note: Pre-anesthetic bloodwork checks the internal organs and blood count and is a vital part of safe anesthesia. Help us provide the best level of care for your pet by choosing to perform bloodwork prior to anesthesia or sedation.

I, the owner/agent for the pet described above, request and authorize an exam for my pet. I understand that the staff at New Richmond Veterinary Clinic will contact me at the number listed above after my pet has been examined to discuss diagnosis and treatment and will have an initial estimate of charges.

I understand payment is due when my pet is discharged, however, a deposit may be required after an estimate is prepared and discussed. I accept financial responsibility for charges incurred for this pet.