Feline Surgery Consent Form

Client First Name: *

Client Last Name: *

Email Address: *

Street Address:

Apartment, suite, etc:

City:

State/Province:

ZIP / Postal Code:

Home Phone:

Cell Phone:

Pet's Name:

Breed:

Color:

Gender:

DOB/Age:

Procedure(s) to be performed:

Please read carefully and sign below

Your pet's health and well being are our greatest concern. Before putting your pet under anesthesia we perform a complete physical examination. We also highly recommend a Pre- Anesthetic Blood Profile to be preformed on all animals. We require this test to be run on all pets over the age of 7 years. This test will help rule out some pre-existing internal problems like dehydration, anemia, diabetes, infection and/or kidney-liver disease. These may not be evident on physical exam, but could lead to serious complications. Although the blood profile does not totally eliminate risks, it greatly reduces the possibility of complications and serves as a baseline for future treatments.Yes, perform pre-anesthetic blood testingNo, I decline pre-anesthetic blood testingNo, done prior on…

Feline Leukemia and FIV

FeLV/FIV are major causes of illness and death in cats. Both are viruses that are spread from cat to cat. The viruses are spread in cat bites, urine, and saliva.

Do you wish to have your cat tested today?YesNo

Additional/Optional Services

Vaccinations:Feline Annual VxFeline LeukemiaRabies vaccine

Medications given and when:

Home Again Microchip System (additional cost)YesNoDone prior

If your pet is found to be infested with fleas or ticks they will be treated at your expense.

I am the owner or authorized agent of the owner and am at least 18 years of age. I hereby authorize Town & Country Veterinary Services to perform the procedure(s) noted above and administer anesthetics or other drugs deemed advisable for my pet. I also understand the increased risks of complications by not performing the pre-anesthetic blood profile. I recognize that there is always risks and agree not to hold Town & Country Veterinary Services or any of its staff responsible and it is understood that I assume all risks and financial responsibility. If I fail to pick up my pet in ten days, the animal will become the property of Town & Country Veterinary Service and may disposed of as deemed best. This does not relieve me from any costs or financial responsibility.

Name of authorized person to pick up my pet after surgery if I (owner) is not available:Will not release pet to anyone other than owner or person listed above. Payment is required at time of pick up.

Owner Signature:

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Please read carefully and sign below

Feline Leukemia and FIV

FeLV/FIV are major causes of illness and death in cats. Both are viruses that are spread from cat to cat. The viruses are spread in cat bites, urine, and saliva.

Additional/Optional Services

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