Two Rivers Pet Hospital

Surgery Consent Form

Surgery/Anesthesia Consent Form

Thank you for choosing Two Rivers Pet Hospital! Please fill out the following form before your pet’s scheduled procedure. If you have any questions, please feel free to give us a call. We look forward to seeing you!

Owner's Name(Required)

First Last

Email(Required)

Patient's Name(Required)

Surgical Procedure(Required)

Owners Number for Pick Up(Required)

Emergency Number

When was the last time the pet was fed?(Required)

Would you like us to microchip your pet during the procedure? ($50 fee)(Required)

Yes

No

Already has one

I am the owner or agent for this animal and have the authority to execute this consent. I authorize the veterinarian(s) and staff of Two Rivers Pet Hospital to render the procedures discussed and/or indicated above. The nature of the procedures has been explained to me and no guarantee has been made as to the results. I authorize the use of appropriate anesthetics and other medications to be used on my pet(s). In the event of death of the animal(s), through no fault of the clinic, I will be 100% responsible for the reasonable costs thereof. I agree to pay, in full, services rendered including those deemed necessary for medical or surgical complications of otherwise unforeseen circumstances. I have read and fully understand the terms and conditions of this consent form as set above.(Required)

I have read and agree

Signature(Required)

Date(Required)

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Two Rivers Pet Hospital

Surgery Consent Form

Surgery/Anesthesia Consent Form

Make a Veterinary Appointment
Great Falls, MT

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