Surgery Consent Form

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Surgery Consent Form

Please fill out this form as completely and accurately as possible and submit at least 24 hours prior to your scheduled procedure.

Contact Information

Like you, our greatest concern is the well being of your pet. Prior to anesthetizing your pet, our doctors will per form a complete physical examination. Please answer the following questions about your pet’s history and present health:

Owner Authorization & Release:



At Hamptonburgh Animal Hospital, we strive to practice quality medicine. We STRONGLY RECOMMEND that pets are properly screened. Many conditions, including disorders of the liver or kidneys or low grade infections can only be detected through blood testing possibly before your pet shows clinical signs of illness. Since most anesthetics are metabolized by the liver or kidneys, disease in one of these organs can increase the risk associated with anesthesia. If a problem is detected during the physical exam or on the blood work, a doctor will contact you to discuss any recommended course of action prior to surgery. Surgery will be postponed if it is deemed to be in the best interest of your pet. **Not needed if done withing past 1 month**


When accepted, the IV Catheter will be placed prior to your pet being placed under anesthesia. In the unlikely event of a crisis while under our care, this allows for medication to be administered rapidly. **NOTE** Hair will be shaved at the catheter site(s).


1 in 3 pets go missing during its lifetime, and without proper ID, 90% never return home. A microchip gives the best protection with a permanent ID that can never be removed or become impossible to read. This is a small chip that is implanted under your pet’s skin on the back of the neck that is used for identifying your pet if he/she gets lost. We suggest that it is implanted while the pet is under anesthesia.


Clients who are having their female pet spayed should be aware that if she is pregnant, the puppies or kittens will all be aborted during the surgery. There is an additional charge for spaying a pregnant animal or an animal that is in heat, has had a previous heat, is overweight, or has retained testicle(s).


For patients scheduled for dental cleanings: a dental cleaning for dogs and cats involves a FULL MOUTH health examination, cleaning, and extraction of teeth if necessary.

Laser Therapy (Photobiomodulation) - Not Used on Growth Removals

Post-operative laser therapy will improve postoperative pain relief and provide faster incision healing. Light energy enters the cells to stimulate intracellular activity to provide these benefits.


For patients scheduled for lumpectomy, we always recommend a biopsy to determine the make up of the removed tissue.


For certain procedures we strongly recommend that you also give pain medications orally for a few days after. This will help to ensure an easier recovery period.

Elizabethan Collar

We recommend that most patients go home with an elizabethan (cone) collar to keep them from licking or chewing at their incision site. They need to wear it for 10-14 days, or until the incision is completely healed. If declined, owners will be financially responsible for additional care that result from your pet chewing or licking at the incision site.