Client Consent Form

  • *This Form is only to be filled out and submitted if you are leaving your pet with us, i.e. overnight, or for a surgery.*
  • (Nail Grind, Express Anal Glands, Data Mars Microchip, Dental, Clean Ears, Annual Vaccines, Etc.)
  • Your Pet's Medical History

    (Note: Because of the added risk to your pet, we do not recommend spaying your pet if she is currently in heat, or is just coming out of or about to come into heat.)
  • (Note: Pets that are overdue for vaccines are required to be made current during time of hospitalization. If vaccines were not given at CVH, verification of the pet’s vaccination status must be obtained from the other clinic.)
    (If NO, a heartworm test will be performed before anesthesia to ensure that your pet is HW-negative. We do not recommend anesthesia/surgery for patients who are HW-positive.)
  • Pre-anesthetic Blood Work

  • Pre-anesthetic blood work is required for all patients undergoing anesthesia who are 5 years of age or older, and is used to help lower the risk to older patients by detecting life-threatening conditions before anesthesia.
  • Authorization

  • I hereby authorize the veterinarian to examine my pet and perform diagnostic, therapeutic, and surgical procedures or treatments as necessary and advisable for the treatment and maintenance of my pet’s health and well-being, including the use of anesthesia. I understand there is always risk with the use of any anesthesia, and that no guarantee can ethically or professionally be made regarding results or cure. I understand I assume financial responsibility for all services rendered, and that payment is due at the time services are rendered. I understand no staff will be attending to my pet overnight. We do NOT accept personal checks (cash, credit, debit, and Care Credit only). Please do NOT leave personal items with your pet, as we cannot be responsible for lost items.
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