Anesthesia Surgical Consent

Name: Lake Hills Veterinary Clinic
Address: 5298 Osage Beach Parkway, Osage Beach, MO, 65065, United States
Telephone: 573-302-8100
Price range: $

Thank you for choosing Lake Hills Veterinary Clinic as your choice! Please fill out the form as completely and accurately as possible.

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Anesthesia Surgical Consent

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. If this is an emergency, or if your pet needs urgent care, please call us at 573-302-8100 for a faster response.

Client Name *

First

Last

Patient Name *

Phone number at which owner can be reached today or tomorrow: *

Additional number

Email *

Before Procedure:

Would you like to be contacted before your pet goes in for the procedure *

Would you like to be contacted by text or phone call before the procedure? *

Text
Call
Either

If text, what number would you like to be texted at?

After procedure:

Would you like us to text you after the procedure, or would you prefer a call? *

Text
Call

Anesthetic and surgical procedure(s) to be performed: *

I, the undersigned owner or agent of the pet identified above, authorize the staff of Lake Hills Veterinary Clinic to perform the above procedure(s). *

I have read and agree

Microchip: *There is an additional fee for this procedure* *

Yes
No
Already has one

Nail Trim: Would you like a complimentary nail trim for your pet? *

Have you given your pets any medications or supplements in the past week? *

Presurgical Pack
Carprofen
Meloxidyl
Other (please specify below)
None

Other medication(s), please specify and note last time given

When was the last time fed?

Any other concerns/allergies/procedures?

I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. *

I have read and agree

I am over 18 and understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures. *

I give my permission [yes]
I do not give my permission [no]

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. *

I have read and agree

Please type your initials. *

Date *

Name

Request An Appointment!

We look forward to seeing you and your furry friend soon! Call us to schedule your next appointment or use our online form.

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Contact Us

Use the form below, and we’ll get back to you as quickly as possible. If you need immediate assistance during business hours, call us at 573-302-8100. We are available for emergency phone consultations after hours. You can also call the 24 hr ER hospital Horton Discovery at 573-777-3609.

Address

5298 Osage Beach Parkway
Osage Beach, MO 65065

Hours

Monday 8am-6pm

Tuesday-Friday 8am-5pm

Saturday 8am-1pm

We are available for emergencies after hours (Mon-Sun)

Contact

573-302-8100
[email protected]

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First

Last

Email *

Phone

How can we help you? *

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