Client and Consent Forms

To ensure the best care for your pet and a smooth experience for you, we’ve made our client consent forms easily accessible online. Please take a moment to fill out the necessary forms before your visit. These forms help us understand your pet’s needs, streamline the check-in process, and ensure we have all the information required to provide the highest standard of care. If you have any questions or need assistance, don’t hesitate to reach out—we’re here to help!

Surgical Consent Form

Owner Information

Owner’s Name

Address

Phone Number

Pet Information

Pet’s Name

Species

Breed

Age

Weight

Color/Markings

Procedure Information

Procedure(s) Scheduled

Date of Procedure

Procedure:
I certify that I am the owner/guardian of the pet described above and have full authority to execute this consent. I certify that my pet has not eaten in the last 10 hours as recommended. I hereby authorize the veterinarian at Headwaters Veterinary Center to perform the surgical procedure(s) listed above.

Initials

Anesthesia and Surgery Risks

I understand that my pet will undergo anesthesia and surgery, and I am aware of the potential risks, including but not limited to:

• Adverse reactions to anesthesia

• Bleeding, infection, or complications during or after surgery

• Rare but serious complications, including death

I acknowledge that no guarantees can be made regarding the outcome of the procedure.

Initials

Pre-Anesthetic Bloodwork
For patients of any age, blood work helps reduce the risk of complications during anesthesia and to ensure a faster recovery for your pet. If the results detect any hidden illness, we can alter the anesthesia or postpone the procedure to ensure your pet’s safety. For pets 8 years and older, as well as pets with pre-existing medical conditions, this blood work is required by our clinic.

Please Select an Option Below

Yes, I authorize pre-anesthetic bloodwork to assess my pet’s health and reduce risks. No, I decline pre-anesthetic bloodwork. I understand this may increase the risk of complications.

Pain Management
I understand that pain management is an important part of my pet’s care. I authorize the use of appropriate pain relief medications before, during, and after the procedure.

Initials

Emergency Care
In the event of an emergency or unforeseen complications, I authorize the veterinarians at Headwaters Veterinary Center to take any necessary measures to stabilize and treat my pet. I understand that additional costs may be incurred.

Initials

Financial Responsibility
I agree to pay for all services rendered, including the surgical procedure, anesthesia, medications, and any additional treatments or diagnostics deemed necessary. I understand that payment is due at the time of service.

Initials

Consent
By signing below, I confirm that:

I am the owner or authorized agent of the pet named above.
I have read and understand the risks associated with the procedure and anesthesia.
I consent to the procedure and authorize Headwaters Veterinary Center to perform the surgery and provide necessary care.

Owner’s Signature

Date

We are searching for our next FT/PT veterinarian! You? Send your resume to [email protected]

Client and Consent Forms

Surgical Consent Form

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