Surgery Authorization Form "*" indicates required fields Or Fill Out Digitally Below:Client Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Pet's Name*Species Cat Dog Breed*Sex* Male Female Color*MarkingsBirthdate*I am the owner or agent for the owner for the described animal and have the authority to execute consent and hereby authorize the following surgery* Yes I understand that during the performance of these procedures unforeseen circumstances may arise which may necessitate an extension of the above procedures. I authorize such procedures to be performed as necessary in the professional judgement of the veterinarian & agree to pay for services rendered. The nature of the procedures has been described to my satisfaction and I realize that no guarantee or warranty ethically or professionally be made regarding the results or cure. I understand that I assume financial responsibility for all services rendered and that payment is due at the time the animal is released. Please be aware that all surgeries require an ECG and per-operative blood work to ensure the well being of your pet Please consider having the Fi Nano microchip implanted while your pet is here today. This will assist in your pet being returned to you if they ever become lost. The cost will be $53 with Free Registration.* Yes No Emergency Phone*Signature*CAPTCHA Δ
