Surgery Consent Form

Authorize pet surgery at South Broward Animal Hospital by completing our consent form, ensuring all details are accurate.

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Surgery Consent Form

Please ensure that all fields in the surgery consent form are completed accurately and thoroughly. Your attention to detail is crucial in providing the best care for your pet.

Owner's Name *

First

Last

Owner's Phone *

Emergency Contact Number *

Owner's Email *

Pet's Name *

Species *

Breed *

Age *

Procedure Information: *

I, the undersigned owner or authorized agent for the above mentioned patient, authorize South Broward Animal Hospital to perform the following surgical procedure(s) on my pet:

Surgical procedure(s) to be performed *

Reason for Procedure *

Date of Scheduled Surgery *

Consent *

I understand that surgery involves inherent risks, including but not limited to infection, bleeding, adverse reactions to anesthesia, and unforeseen complications. I have been informed of these risks and understand that while every effort will be made to ensure the safety and well-being of my pet, complications may arise. I consent to the performance of the above-named procedure(s) and any additional procedures deemed necessary by the attending veterinarian(s) during the surgical process.

Financial Responsibility *

I agree to pay all fees associated with the surgical procedure(s) and any additional services rendered. I understand that payment is due at the time of service unless prior arrangements have been made.

Emergency Contact Authorization *

I authorize South Broward Animal Hospital to contact the designated emergency contact in the event of an emergency during the surgical procedure.

Signature *

Clear Signature

Today's Date *

Surgery Consent Form

Surgery Consent Form

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