Owner *

First Name

Last Name

Phone number you can be reached at *

(###)

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Another person who can make decisions concerning my pet is *

First Name

Last Name

Phone number they can be reached at *

(###)

###

####

I would like my cat to have *

Front declaw

Front and Rear declaw

Pre-anesthetic Blood Safety Screen *

Our on-site laboratory helps us screen for hidden problems before your pet’s procedure begins. These tests also provide a baseline for monitoring your pet during procedures, and can indicate chemical imbalances that could affect your pet under anesthesia. We require that all pets have a blood panel done within 60 days of the procedure.

I authorize Northwest Animal Hospital to perform pre-anesthetic blood work, at the charge of $102.00-230.00, depending on the level of testing required.

I do not authorize Northwest Animal Hospital to perform pre-anesthetic blood work. I have been informed that there are some conditions that may not be detected without a pre-anesthetic profile.

Dental Cleanings/Extractions *

I understand that during a dental cleaning my animal’s teeth and gums will be evaluated. Dental extractions may be indicated due to exposed gums, infection, cracks, fractures, etc. We ask that you okay extractions prior to the dental, as to give your pet less time under anesthesia. Our doctors will only pull teeth that are loose, broken, or in need of extractions.

I authorize Northwest Animal Hospital to perform extractions which are deemed necessary.

I do not authorize Northwest Animal Hospital to preform necessary extractions. I am aware that there are health risks associated with untreated dental disease.

My pet is not receiving a Dental Cleaning.

Authorization and Risk Assessment *

I authorize anesthesia/surgery for my pet. The nature and risks of this procedure have been explained to me. I understand that some risks exist with anesthesia and/or surgery and I am encouraged to discuss any concerns associated with risks with my veterinarian before the procedure(s) are started. My signature on this consent form indicates that questions have been answered to my satisfaction. I authorize, Northwest Animal Hospital to perform any additional diagnostic, treatment or surgical procedure(s) deemed necessary for medical or surgical complications or any unforeseen circumstances. While Northwest Animal Hospital provides anesthesia monitoring and surgical services, I understand the risks and understand that the veterinarians and hospital team will do everything possible to reduce any risks. I will not hold Northwest Animal Hospital, the veterinarians or any team member liable for any complications that may arise. I assume full financial responsibility for this animal.

I HAVE READ AND FULLY UNDERSTAND THIS SURGERY AND ANESTHESIA CONSENT FORM