Surgery Consent

Please complete the form below as accurately and completely as possible. If you have any questions, you can contact us at 419-517-5042.

Client Name *

First

Last

Phone *

Email *

Patient Name *

Procedure being performed:

I verify I am the owner (or Authorized agent for the owner) of the above named pet and authorize the above procedure to be performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. *

I have read and agree

I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always a risk associated with any anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgement. *

I have read and agree

I accept responsibility for any result in additional charges. I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. *

I have read and agree

I acknowledge that I received an estimate of cost for this procedure and consent to this estimate of cost. *

I have read and agree

Best phone number(s) to reach you at while your pet is in our care: *

Additional phone number

Last time had food:

Last time had water:

Special feeding instructions:

Current Medications:

Any Preventives (such as Interceptor or Simparica) needed today?

If your pet is not microchipped, would you like your pet to be microchipped today while under anesthesia for an additional $36.50? *

When you arrive for your pets procedure drop off appointment, please call us at 419-517-5042. The call may go to voicemail, upon listening to voicemail options, please select option 1 to reach a hospital staff member.

Client Signature *

Today's Date *

Compassionate veterinary care in Sylvania, OH!

We treat each patient as our own. Our team is here to help when you need us most! We look forward to seeing you.

Location

7851 W Sylvania Ave.
Sylvania, OH 43560

Hours

Mon – Fri: 8:00am – 6:00pm
Sat: 8:00am – 1:00pm

Please Note: We are closed from 1pm to 2pm, Monday through Friday.

Contact Info

Phone: 419-517-5042
Email: info@timberstonevet.com
Fax: 419-517-5044