Two Rivers Pet Hospital Surgery Consent Form Get Started 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) Pet's Name(Required) First Phone number at which owner can be reached(Required)Additional NumberWhen was the last time the pet was fed?(Required) Would you like us to text you after the procedure, or would you prefer a call?(Required) Text Call Would you like us to microchip your pet during the procedure? (There is an additional fee)(Required) Yes No Already has one 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. I do hereby give Two Rivers Pet Hospital, agents, doctors, and/or representatives the full, and complete authority to perform the surgical procedure If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures. 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.(Required) I have read and agree Signature(Required)Date(Required) MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged.