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Brandon Lakes Animal Hospital
Procedure being done today:
I am the owner of agent of the above-described animal and have the authority to execute this consent. I hereby consent and authorize the performance of the above procedure(s) or operation(s) nd authorize the performance of other procedure(s) or operation(s) necessary and desired in the exercising of the veterinarian's professional judgement. The nature of such service has been described to me to my satisfaction and I realize that no guarantee, or warranty can ethically or professionally be made regarding the results or cure. I understand that surgery carries some risk regardless of health status. I have been advised that there is a risk of death every time an anesthetic is used and that possibility (small as it may be) has been explained to me. In the event of unforeseen complications, I give permission for the doctors and staffto take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action.
Please check the boxes below to ensure you understand what is being asked of you
If your pet is presented to the hospital with fleas, we will give is a safe flea medication to eliminate the fleas. The cost of this service is $10.00
Some animals can become frightened or aggressive while in an unknown environment, making it difficult to examine. If this case I give my consent for the Doctor(s) to use necessary sedation for my animal. I understand that if this is the case there will be a fee. I realize that there is a risk (although small) involved with any type of sedation and those risks have been explained to my satisfaction.
We try our best to provide you with an accurate estimate of charges, however there are times that we must alter the initial estimate that you were given. In that event we will call you to discuss charges with you.
A pre-payment equal to the estimated amount is required. Should the payment exceed the final bill, the balance will be refunded or credited to your account.
Please read the following carefully and initial next to procedures you wish to be performed in the case of an emergency.
In the event of cardiac or respiratory arrest I authorize the responsible veterinarian to resuscitate my pet by performing one or more of the following procedures:
Yes to resucitation:
No to resucitation: I consent in the event of cardiac or respiratory arrest that NO attempts to resuscitate my pet be performed.
I understand that I assume financial responsibility for all services rendered, and that payment is expected on the day of surgery. Any medications and supplies purchased will be at an additional charge.
Date / Time