General Surgery or Drop Off Consent Form

If your cat is coming to us for a surgery or is staying with us for a long period of time without your presence, please complete this form. Filling out this form prior to your arrival will allow for a quick and easy drop off!

Which practice would you like to register with?

Location

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Patient's Name *

Procedure *

Full Name *

Email Address *

I, being the owner or authorized agent, hereby authorize Pacific Cat Clinic, Dr. Helen Bell or other authorized veterinarian to perform and provide all necessary hospital services, drugs and medical supplies as are reasonably required in the treatment of my cat. I understand that there is some risk involved during medical, surgical and anesthetic procedures. I agree to be responsible to pay all of the reasonable and appropriate charges for these services at the time of discharge.

Signature *

Date

Today

Permission to sedate if necessary (please initial) *

If my cat develops unexpected complications and other emergency procedures are necessary above and beyond the initial procedure discussed, I understand that Pacific Cat Clinic will try to contact me. In the event that I am unreachable and the procedure cannot be safely delayed, I choose the following: *

Proceed with standard required treatment
Stop treatment until I can be contacted

If a flea is found on my pet during its stay at the clinic, they will be administered a CAPSTAR tablet at my expense. *

I agree

Please verify that you are human *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *