916-689-1688 Staff@hattonvet.com

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Anesthesia Consent Form

Thank you for choosing Hatton Veterinary Hospital.

Anesthesia Consent Form

Before your appointment, please complete this form as thoroughly and correctly as you can so that we may get to know you and your pet(s).

Client Name *

First

Last

Email *

Pet’s Name *

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Primary Phone *

Secondary Phone

Procedure(s) *

Last time food was offered to patient *

Last time water was offered to patient *

Please list all medications your pet is taking *

Please write N/A if your pet is not on any medications.

List any belongings left with your pet (i.e., carrier, leash, collar, etc.) *

The hospital will not be responsible for any lost items.

I would like a microchip implanted at the time of surgery for an additional $35 fee. I understand that I must register this chip on my own online to complete the activation process. *

Yes
No

Please initial after each statement below:

I hereby consent that I am the owner/ agent of the above animal and have the authority to execute this consent. I further understand that during the performance of the foregoing procedure(s) unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s). Therefore, I hereby consent to and authorize the performance of such procedures(s) that are necessary and desirable in the exercise of the veterinarian’s professional judgement. I have also been advised as to the nature of the procedure(s) and the associated risks involved. I understand that results cannot be guaranteed. *

I have read and understand

I understand that unforeseen conditions may be revealed during the process that may require more extensive or different treatments. I understand that all reasonable efforts will be made to contact me to authorize any additional treatments. However, if these efforts are unsuccessful, I authorize the performance of any procedures or treatments that are deemed immediately necessary for the health and wellbeing of my pet in the professional opinion of the attending veterinarian. *

I have read and understand

I understand that I assume financial responsibility for all services rendered. *

I have read and understand

All anesthetic procedures include a physical exam, IV catheter and anesthetic monitoring. The cost for these services is included in the cost of the above described procedure.

Pre-Anesthetic Blood work

There are certain risks involved with any anesthesia or surgical procedure. Many conditions may not be detected upon routine examination such as disorders of the liver, kidneys and blood. Laboratory testing can reveal unforeseen conditions and allow proper measures to be taken prior to any such procedure. *

The additional cost for this test is $110. Initial here if you would like this test performed

Please check off any additional services needed while your pet is with us:

Vaccines
FeLV/FIV test
Check ears
Microchip
Pedicure
*Flea treatment

I understand that for the safety of the other pets in the clinic, if fleas are seen on my pet he/she will be treated and I will be financially responsible for the treatment cost. *

I have read and understand this authorization.

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Owner/Authorized Agent Signature *

Clear Signature

Date *

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At Hatton Veterinary Hospital of Elk Grove, CA, we take veterinary medicine to the next level. Book an appointment for your pet using our online system.

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Questions?

Please complete the form below, and a member of our team will get back to you as quickly as possible.

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Location

7615 Sheldon Rd.
Elk Grove, CA 95758

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Contact Information

Phone: 916-689-1688
Email: Staff@hattonvet.com

After Hours Emergency Contact:

Mueller Pet Medical Center: 916-428-9202

Vista Veterinary Specialist: 916-231-4445

Sacramento Veterinary Referral Center: 916-362-3111

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Hours

Mon-Fri: 8:00 AM – 6:00 PM
Sat: 8:00 AM – 4:00 PM
Sun: Closed

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Email *

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How can we help you? *

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