Surgery Consent Form

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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.

Pet Information

Contact Information

Like you, our greatest concern is the well being of your pet. Prior to anesthetizing your pet, our doctors willperform a complete physical examination.

Please answer the following questions about your pet’s history and present health:

**** If parasites (fleas, ear mites, intestinal parasites, etc.) are found on your pet while visiting our facility, we willtreat the pet with the necessary treatment at the owner's expense for the protection of your pet and that of othersin the hospital.

**** Clients who are having their female pet spayed should be aware that if she is pregnant, the puppies or kittenswill all be aborted during the surgery. There is an additional charge for spaying a pregnant animal or an animalthat is in heat.

**** All pets over six months of age are required to be vaccinated for rabies according to state law. If your pet hasnot had the rabies vaccine prior to his/her visit, or if proper documentation cannot be provided, the pet must bevaccinated for rabies while here at the owner’s expense.

Owner Authorization & Release:



At Hamptonburgh Animal Hospital, westrive to practice quality medicine. We STRONGLYRECOMMEND that pets are properly screened. Many conditions, including disorders of the liver or kidneys or lowgrade infections can only be detected through blood testing possibly before your pet shows clinical signs ofillness. Since most anesthetics are metabolized by the liver or kidneys, disease in one of these organs canincrease the risk associated with anesthesia. If a problem is detected during the physical exam or on the bloodwork, a doctor will contact you to discuss any recommended course of action prior to surgery. Surgery will bepostponed if it is deemed to be in the best interest of your pet.


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


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


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


For patients scheduled for lumpectomy, wealways recommend a biopsy to determine the make up ofthe removed tissue.