Surgical Consent Form

I, the undersigned owner, agent of the owner, or Good Samaritan responsible for seeking veterinary care for the pet identified above, certify that I am eighteen years of age or over. I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always a risk associated with anesthesia, even in apparently healthy animals, and have discussed any concerns with my veterinarian. I understand that it may be necessary to provide emergency medical and/or surgical procedures which are not anticipated for the safety and care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgement. I hereby certify that I have read and fully understand the above authorization for medical and/or surgical treatment, the reasons why surgery is necessary, its advantages and possible complications. The attending veterinarian will use reasonable precautions for the well-being of my pet but will not be held liable for conditions beyond his/her control. I agree to assume financial responsibility for all fees incurred during the care of my pet and will provide payment via cash or credit card at the time my pet is discharged from the hospital. I understand that any unpaid balance will result in a 5% interest charge if left unpaid for over 30 days. I also understand that any balance left unpaid for over 60 days will result in my account being turned over to collections and I will be responsible for any collection fees, court cost and interest charges.

I understand that Rock Creek Veterinary Hospital reserves the right to charge a cancelation fee in the amount of $60 when the appointment is not cancelled within 24 hours of the scheduled appointment time. In the event the patient is more than 15 minutes late to the appointment it is up to the discretion of the doctor to determine if there is enough time on the schedule to see the patient. If the doctor decides they are willing to see the patient there is a $25 late fee. If the doctor decides there is not enough time you will be asked to reschedule to a later date at no charge.