Please note: We are moving to 32 Enterprise Drive Danville, PA 17821 changing as of March 4, 2024

Surgical Consent Form

Name: Caring Hands Animal Hospital
Address: 1839 Montour Blvd, Danville, PA, 17821, United States
Telephone: 570-275-0202
Price range: $

Thank you for choosing Caring Hands Animal Hospital as your preferred Danville, PA, veterinarian! Please fill out the following form as accurately as possible.

Anesthesia / Surgical Consent Form

We are glad to have the opportunity to care for your pet. To ensure your pet gets the best care we can offer, please fill out the following form completely. Please Note: All * fields are required.

Client Name *

First

Last

Patient Name *

Phone number at which owner can be reached the day of surgery *

Additional number

Email *

Before Procedure:

Would you like to be contacted before your pet goes in for the procedure *

After procedure:

Would you like us to call you after the procedure? *

Anesthetic and surgical procedure(s) to be performed: *

I, the undersigned owner or agent of the pet identified above, authorize the staff of Caring Hands Animal Hospital to perform the above procedure(s). *

I have read and agree

Microchip: *There is an additional fee for this procedure* *

Yes
No
Already has one

Nail Trim: Would you like a complimentary nail trim for your pet? *

Have you given your pets any medications or supplements in the past week? *

Yes, Presurgical Pack
Yes, Other medication(s), please specify below
No

Other medication(s), please specify and note last time given

When was the last time fed?

Any other concerns/allergies/procedures?

I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. *

I have read and agree

I am over 18 and understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures. *

I give my permission [yes]
I do not give my permission [no]

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. *

I have read and agree

Date *

Comment

We Can’t Wait to Meet You

Ready to schedule your next appointment? Fill out our online appointment request form here.

APPOINTMENT

Contact Us

It is our mission to make every client and their pet feel comfortable from the moment they walk through the door.

Questions?

Get in touch! Complete the form below and a member of our team will be in touch with you shortly.

Name *

First

Last

Email *

Phone

How can we help you? *

Message

Hours

Monday – Friday: 7:00AM – 7:00PM
Saturday: 8:00AM – 12:00PM
Sunday: Closed

Contact Us

It is our mission to make every client and their pet feel comfortable from the moment they walk through the door.

Address

1839 Montour Blvd
Danville, PA 17821

Phone

570-275-0202

Fax

570-275-3043

Email

leighowveterinaryhospital@gmail.com

Hours

Monday – Friday: 7:00AM – 8:00PM
Saturday: 8:00AM – 12:00PM
Sunday: Closed

Questions?

Get in touch! Complete the form below and a member of our team will be in touch with you shortly.

Name *

First

Last

Email *

Phone

How can we help you? *

Phone