Client Consent Form - Bell County Animal Clinic

Date

Owner's first name

Owner's last name

Emergency Phone

Pet's Name

Species

Dog Cat

Sex

Male Female

As the Owner, or duly authorized agent of the owner, of the above described animal, I give my consent to the Bell County Animal Clinic personnel to anesthetize the above animal and perform the following procedure:

I understand that during the performance of this procedure(s), unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect the Bell County Animal Clinic to use reasonable care and judgment in performing the procedure(s). The nature of the procedure(s) and risks involved have been explained to me, and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding this animal.

Bell County Animal Clinic highly recommends pre-anesthetic blood work to further ensure the safety of your pet. The Clinic also offers electrocardiograph (EKG) heart monitoring for all pets as well as screening for feline leukemia (FeLV) and feline immunodeficiency virus (FIV) for cats. We offer surgical laser which reduces pain and bleeding, as well as speeds healing after surgery. Please check any procedures you’d like to add:

Pre-anesthetic blood work – $65.61 Electrocardiograph (EKG) during surgery – $35.62 Intravenous (IV) fluid therapy – $34.50 Feline leukemia/immunodeficiency virus (FeLV/FIV) testing – $49.39 Hw occult/Lyme/Erlichia Test – $32.86 Surgical Laser(does not include declaws) – $43.41 Do you want your pet to receive Post-surgical Pain Medication? (additional cost)

*If your pet is over 6-years-old, please give us a call for pricing.

Signature