Owner Information

Owner’s Full Name *

First

Last

Phone Number *

Email *

Pet Information

Pet’s Name *

Species *

Cat
Dog

Breed *

Age *

Sex *

Male
Neutered Male
Female
Spayed Female

Procedure Details

or has &

Scheduled Procedure(s) *

Date of Surgery *

Does your pet have any known allergies or medical conditions? *

Yes
No

If yes, please list *

Current Medications (Name & Dosage)

Would you like to authorize any additional services while your pet is under anesthesia? Please specify below.

Anesthesia & Surgery Consent

I hereby authorize FairPet Surgery Center and its designated veterinary team to perform the procedure(s) listed above. Additionally, if an emergency arises and I cannot be reached, I consent to any necessary diagnostics, treatments, or surgical procedures deemed essential for my pet’s health and well-being. *

I understand and accept.

I confirm that my pet has been on regular flea and parasite prevention. I understand that if fleas, ticks, or other parasites are found during the visit, appropriate treatment may be recommended to ensure my pet’s health and prevent the spread of parasites to other animals. *

I acknowledge that my pet has been regularly protected against fleas and parasites with appropriate preventive care.
My pet has not been on regular flea and parasite prevention. I understand that if fleas, ticks, or other parasites are found, treatment may be necessary to protect my pet and prevent the spread of parasites.

I acknowledge that the veterinarians and staff at FairPet Surgery Center will perform all procedures, including anesthesia administration, to the best of their abilities. However, I understand that no guarantees or warranties have been made regarding the outcome of the procedure. I accept full responsibility for any additional costs that may arise after surgery, including follow-up exams, imaging, or further procedures due to post-operative complications. I understand that anesthesia and surgery carry inherent risks and that complications are more likely if post-surgical care instructions are not followed. I have received an estimated cost for the recommended procedure(s) and agree to provide full payment at the time of my pet’s discharge. *

I have read and understand the terms outlined above.

Signature *

Clear Signature

Date *

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Surgery and Anesthesia Consent Form