Consent Form

We look forward to treating your pet!

Highland’s Pet Medical Clinic is proud to provide the best possible care and treatment for your pet.

Consent Form

Please fill out the following form before your scheduled surgical appointment. If you have any questions, do not hesitate to call us. Please note: All * fields are required.

Name *

First

Last

Email *

Pet's Name *

Pet's Age *

Procedure(s) Your Pet Is Receiving *

Dental Extractions: Since it is difficult to predict the extent of dental disease from a visual exam, variations from the original treatment plan may occur after dental radiographs are performed. If while my pet is anesthetized, the doctor determines that additional treatment is needed: *

Proceed with any treatment that the doctor deems medically necessary
Contact me via phone at the number listed below prior to performing any treatment other than what was previously discussed (please note that if you do not answer your phone when the doctor calls, the doctor will proceed with any medically necessary procedures)
My pet is not having a dental procedure

Anything else needed while pet is under anesthesia?

Emergency Phone Number *

While undergoing these procedures your pet will receive anesthetic drugs that prevent pain. Because we care about your pet’s comfort and strongly believe that pain relief is important, additional pain medications will be provided as needed to control the level of your pet’s discomfort after surgery and during their recovery.

I am the owner (or authorized agent of the owner) of the animal described above and have the authority to execute this consent. I understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian and understand that it may be necessary to provide additional medical or surgical treatment to my pet in the event of unforeseen circumstances. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics and other medications and any such additional treatment, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read and fully understand this consent. *

I have read and understand.

The fees associated with these services have been explained to me, and I agree to pay such fees at the time my pet is released from the hospital. If an estimate was provided, I understand that it is an estimate and if complications are involved, or if the procedure is of greater dimensions than anticipated, the price may be higher than the estimate projected. *

I have read and agree.

Signature *

Today's Date *

Name

Consent Form

We look forward to treating your pet!

Consent Form

We proudly serve the pets of Austin, TX, and beyond.

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