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Consent Form for Tranquilizers, Surgery, and Dental Procedures

Owner's Name(Required)
Please be aware that these contact numbers are used to contact you during procedures if necessary. Please give a number that you will be available to answer.
I am the owner or designated representative of the above mentioned pet. I consent to the above listed procedure(s) and authorize Norwalk Animal Hospital to administer anesthetics and/or tranquilizers, including appropriate medications to my pet. I understand there are potential risks when using anesthetics and/or performing surgery and that no results are guaranteed. In the event of an adverse reaction, I authorize the doctor to do what is in the best interest of my pet.(Required)
MM slash DD slash YYYY
Pre-operative instructions: Please do not feed your pet after 12am midnight the evening before a scheduled procedure. There is no restriction on drinking water. Plan to arrive at the hospital between 8-9am and allow 30 minutes for check-in procedures.
Surgeries and Dentals typically take place between 11am and 3pm. You will receive a call from a doctor or technician when your pet is in recovery. If your pet is to go home on the same day, they will be discharged between 4:30pm and 6pm. If they need to stay overnight they would go home at 10am the following morning.

Please complete this section if your pet is receiving a TRANQUILIZER:

Check all that apply:
(Required)

Please complete this section if your pet is here for ANESTHESIA (SURGERY and DENTAL patients):

We routinely run pre anesthetic bloodwork to check your pets health prior to anesthesia, the following would be in addition to that bloodwork and additional charges would apply. Please check any additional testing below you would like us to do.

Please complete this section if your pet is here for a DENTAL procedure only:

Evaluations under anesthesia may reveal hidden dental disease that could not be identified in your pet’s exam. Please indicate below how you would like the doctor to proceed with any treatments:
*additional charges will apply for any procedures beyond basic cleaning and polishing. ** additional anesthesia time and charges are required for phone consultation delays.

Please complete if your pet is here for a SPAY or NEUTER only:

We recommend removing deciduous teeth that have not yet fallen out as they can cause the emerging adult teeth to be pushed out of alignment, causing bite issues.
Add upgraded bloodwork (advanced chemistry)?
I understand that an estimate of fees for the above services will be provided to me upon my request and may vary significantly depending on the need for additional services. I am encouraged to discuss all fees before services are rendered. If additional work is needed and agreed to during a phone consultation I will be responsible for payment.(Required)
I certify that I am 18 years of age or over and agree to assume financial responsibility for the service fees. Payment is due in full at the time my pet is discharged.(Required)
Owner Name(Required)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.