Surgical ConsentForm

I am the owner or agent for the owner of the aforementioned pet and have the authority to execute this consent. I hereby authorize the Williamsburg Veterinary Clinic to perform the services noted above for my pet/s. I understand that some risks always exist with anesthesia and/or surgery, and I have been encouraged to discuss any concerns I may have about those risks with my veterinarian before the procedure(s) is/are initiated. Surgical and anesthetic risks include, but are not limited to, infection at the surgical site, unexpected blood loss, and anesthetic or surgical complications up to and including death.

Additionally, I hereby authorize the Williamsburg Veterinary Clinic to perform any diagnostic, treatment, or surgical procedures as deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. While the Williamsburg Veterinary Clinic provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. I fully understand these risks and understand that the veterinarians and hospital staff will try to minimize these risks. I agree not to hold the Williamsburg Veterinary Clinic, the veterinarians, or any staff member liable for any complications that may arise.

Should my pet be found to harbor any fleas, I will also assume the charges for de-fleaing my pet while in the hospital. I have read and do understand this estimate.

Should my pet be discharged from the hospital with an unpaid balance, I understand and agree to pay a finance charge of 1.5% per month on any unpaid balance. Any attorney or collection fees incurred due to delinquency in payment will be my responsibility.

No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures.

My signature on this consent form indicates that any questions I may have were answered to my satisfaction.