Consent for Surgery or Dental Procedures Form

Consent for Surgery or Dental Procedures

    Client Information

    Patient Information

    PREANESTHETIC BLOOD TESTING: *Mandatory for all animals over 6 years of age*



    See Estimate $39.00

    INTRAVENOUS FLUID THERAPY: *Mandatory for all dental procedures, brachycephalic breeds, dogs under 4 kg, cats
    under 2 kg, and animals over 6 years of age*


    DENTAL RADIOLOGY: *Mandatory for all extractions*


    $35.00 ea.

    HISTOPATHOLOGY: : *For lump removals only*


    With a routine spay or neuter there are other medical conditions that we may come across during our pre-surgical exam. If any of the following are found we will attempt to contact you prior to beginning of surgery.

    Cryptorchid Inguinal $95

    Umbilical Hernia Female $84

    In Heat $46

    Cryptorchid Abdominal $265-290

    Umbilical Hernia Male $115

    Additonal Anesthetic $73/30 mins

    In the event I cannot be reached, Sage Creek Animal Hospital has permission to proceed with medical care for:

    I hereby authorize and direct the veterinary staff of the Sage Creek Animal Hospital to perform the above-mentioned procedure(s)and additional diagnostic and /or treatments as deemed advisable or necessary for my pet. The nature of the procedure(s) has been fully explained and I understand them.

    I also certify that no guarantees or assurances have been made regarding the results that may be obtained. I understand there may be risks involved in the procedure(s).

    Furthermore, I accept the financial responsibilities for all charges incurred to be settled at the time of discharge unless otherwise arranged with the hospital. I understand that any written or quoted estimates are an approximation and the costs may be more or less than the amounts.

    With my signature I hereby certify that I have read and fully understand the above statements

    Sage Creek Animal Hospital reserves the right ensure all pets are sent home with an appropriate restraint system such as a carrier or a leash. In the case that the owner cannot provide a carrier or leash, Sage Creek Animal Hospital will supply one for a fee which may or may not be refundable.