Surgical consent form

Please complete these questions prior to your visit with us for your pets surgical appointment. Best regards Roncesvalles Animal Hospital
  • This person should be the owner on account, responsible for decisions and payments and of legal age.
  • Please keep your phone on and be available to answer it while we have your pet in the clinic.
  • The nature of such services has been described to my satisfaction, and while I accept all procedures to be done to the best abilities of the professional staff, I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure. I hereby release Roncesvalles Animal Hospital and staff from any, and all, liability arising from the surgical procedure(s), to be performed on my pet. In particular, I understand that in the event that the treatment requires the use of anesthesia, that there is a risk of death every time an anesthetic is used.
  • The performance of the identified procedures and the use of associated anesthetics and other medications. I also understand that unforeseen conditions may be revealed during the identified procedures which, in the opinion of the attending veterinarian, require more extensive or different procedures or treatments. I understand that reasonable efforts will be made to contact me to explain these procedures and treatments and obtain my instructions regarding them. However, if the efforts are unsuccessful I authorize the performance of any procedures and treatments which are necessary in the professional opinion of the attending veterinarian. Additional charges may apply. We will make every effort to keep within the estimate but sometimes procedures take longer than expected or differ from the estimate and the price may vary.
  • To pay the total as per the estimate given, for the above procedures and related clinic fees. I will pay a deposit prior to the procedure and the balance at the time the pet is discharged and hereby acknowledge my indebtedness for this amount. In the event that the pet referred to above is not claimed by the person giving consent within ten (10) days of completion of treatment and convalescence or of any ancillary services provided by the Roncesvalles Animal Hospital, the pet shall be deemed to have been abandoned, and the Clinic shall be entitled to transfer the pet to an animal shelter or to a third (3rd) party owner. The Clinic waives its lien rights under the Repair and Storage Liens Act. Abandonment does not release me of my obligation for payment of services rendered.
  • IMPORTANT COVID-19 HOSPITAL PROTOCOL: If you are showing signs of cold, flu, or have traveled recently please inform us and we will be happy to reschedule your appointment. To keep our staff and clients safe, we are working on a LOCKED DOOR POLICY.