Anesthesia & Surgery Consent Form

Save time at your pet’s procedure by completing our required surgery consent form online before your visit.

Get Started

Start here.

Help us ensure your pet’s surgery goes smoothly — please complete this form before their procedure.

Owner's Name *

First

Last

Patient's Name *

Email *

Phone *

I, being responsible for the above described animal, hereby grant Dr. Satowski and/or her associates to receive, prescribe for, treat, and/or operate upon my pet.

Companion Care Veterinary Hospital will use all reasonable precautions against injury, escape, or other complications (up to and including death) of or to my pet, but I will not hold Companion Care Veterinary Hospital liable or responsible in any manner, as it is thoroughly understood that I assume all risks.

If serious complications arise, I: *

DO wish Dr. Satowski and/or her associates to employ extreme lifesaving and/or resuscitative measures.
DO NOT wish Dr. Satowski and/or her associates to employ extreme lifesaving and/or resuscitative measures.

I understand that all charges shall be paid upon my pet's release from the hospital. I understand that it is in my pet's best interest to bring him or her in for recommended follow-up appointments, to give them all of the prescribed medications as prescribed by Dr. Satowski and/or her associates, and to contact Companion Care Veterinary Hospital immediately if any complications arise.

After carefully reading the above, I have signed in agreement. I understand the surgery, treatment, and/or other procedures to be performed on my pet, and I acknowledge that it has been explained to me.

Name of Responsible Party *

First

Last

Signature of Responsible Party *

Clear Signature

Date *

Anesthesia & Surgery Consent Form

Start here.

Ready for a visit?Make an appointment

Visit Our Hospital