Please note: We will be closing at 12 PM on Tuesday, December 31st and will remain closed on Wednesday, January 1st for New Years!

Client Forms

Specialty Surgery Consent Form

Save time at your pet’s surgery appointment! Complete your required specialty surgery consent form online before your visit.

Specialty Surgery Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Client Name *

First

Last

What is the best phone number to reach you at today? *

Email *

Patient Name *

Date of Appointment

Is your pet on any current medications?

No
Yes - please notify CVT or veterinarian

Preanesthetic bloodwork, IV catheter placement, and administration of IV fluids during anesthesia are required for specialty surgeries.

Depending on the procedure, you may have the option to use Nocita- a local analgesic for post-surgical pain that lasts up to 72hrs. The cost for this injection is dependent on weight, but typically ranges between $200-315. *

Yes, I would like my pet to receive a Nocita injection.
No, I would not like my pet to receive a Nocita injection.

I understand that unforeseen conditions may be revealed during the procedures that may require more extensive or different treatments. I understand that all reasonable efforts will be made to contact me to authorize any additional treatments. However, if these efforts are unsuccessful, I authorize the performance of any procedures or treatments that are deemed immediately necessary for the health and wellbeing of my pet in the professional opinion of the attending veterinarian.

I understand that I assume financial responsibility for all services rendered.

The veterinarian has described the procedures identified in the consent form and has explained to my satisfaction the purpose for performing them and the risks involved with them. I realize that there can be no guarantee as to the outcome of any procedures.

I hereby authorize anesthesia/surgery for my pet. I understand that some risks always exist with anesthesia and/or surgery. My signature on this consent form indicates that any questions have been answered to my satisfaction. While KM Regional Veterinary Hospital provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. In particular, I have been advised that there is an extremely small risk of death, complications, or side effects every time an anesthetic is used and that I have been advised of the possibility. I acknowledge these risks and understand that the veterinarians and hospital staff will try to minimize such risks. I will not hold KM Regional Veterinary Hospital, the veterinarians, or any staff member liable for any complications that may arise.

I have read and understand this authorization. *

An estimate will be gone over with you before the procedure. Please be aware that the final invoice must be paid in full on the day of service. *

I understand

Signature *

Clear Signature

Date *

Do we have your permission to post any cute pictures we take of your pet on our professional social media outlets? We will not post any personal information or offensive material. *

Yes please!
No thank you.

Client Forms

Specialty Surgery Consent Form

Specialty Surgery Consent Form

Preanesthetic bloodwork, IV catheter placement, and administration of IV fluids during anesthesia are required for specialty surgeries.

The specialty surgeon will call you after the surgery is done to go over post surgical instructions.

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Hospital Policies

Client Forms

Specialty Surgery Consent Form

Specialty Surgery Consent Form

*Preanesthetic bloodwork, IV catheter placement, and administration of IV fluids during anesthesia are required for specialty surgeries.*

The specialty surgeon will call you after the surgery is done to go over post surgical instructions.

Preanesthetic bloodwork, IV catheter placement, and administration of IV fluids during anesthesia are required for specialty surgeries.