Name: McPhillips Animal Hospital
Address: 2211-B McPhillips St., Winnipeg, MB, R2V 3M5, CA
Telephone: (204) 589-8381

Surgical Consent Form

Please complete this electronic surgical consent form prior to your pet’s surgery date.

Name*
First Last
Pet's Name*
Date of Surgery*
Date Format: MM slash DD slash YYYY
Consent 1
Pre-anesthetic bloodwork is recommended for all patients that are undergoing anesthesia. This bloodwork allows your veterinarian to assess your pet’s overall health, ensuring that your pet is a good candidate for anesthesia. If pre-anesthetic bloodwork shows any abnormalities, these abnormalities can be addressed by making any necessary adjustments to your pet’s treatment plan. *We do recommend that pre-anesthetic bloodwork be done prior to your pet’s procedure date. Please click hereto learn more about pre-anesthetic bloodwork.
Please select one of the following:*
- I DECLINE pre-anesthetic bloodwork. I understand the risks involved.
- I ACCEPT pre-anesthetic bloodwork and will call today to schedule my pet in for an appointment.
- My pet has had pre-anesthetic bloodwork done in the last 30 days.
Consent 2
Please indicate whether you would like each of the following:
I wish my pet to receive a complimentary nail trim while under anesthetic*
- Yes
- No
I would like my pet to receive a microchip while under anesthetic (please see estimate for price)**
*Please note, if your pet is being spayed or neutered, a complimentary humane society tattoo is included in the surgery.
- Yes
- No
If there are any other services you would like done, please outline below:
(We will contact you if we have any questions)
Consent 3*
I understand that McPhillips Animal Hospital requires post-operative pain medication(s) with this procedure, and that the cost of the pain medication that will go home with my pet will depend on my pet’s weight and the medication suitable for my pet.
Consent 4*
I hereby authorize McPhillips Animal Hospital to use general anesthesia on my pet, for the treatment/surgery listed on the estimate I was provided. I understand that anesthesia poses a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. The anesthesia and relevant costs have been fully explained to me to my satisfaction.
Contact Info
Contact Name*
First Last
What is the BEST number to reach you on the day of surgery?*
Alternate phone number
If above contact cannot be reached, please contact:*
First Last
Phone*
Consent 5*
I hereby authorize McPhillips Animal Hospital to perform the procedure listed on this proposed treatment plan. I acknowledge that I am the owner/appointed caregiver of the animal described above. I understand that any procedure poses a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver of my pet, I understand that by signing this proposed treatment plan, I agree to pay for all the fees as shown on this treatment plan and will pay the balance in full upon discharge of my pet. The procedure and relevant costs have been fully explained to me to my satisfaction.
Consent 6*
I acknowledge that this may not be the total charges related to the proposed treatment plan. I also acknowledge that if further treatment is required, additional charges will apply.
Type Name here to signify a signature of you, the authorized owner and caregiver of this pet*
Date*
Date Format: MM slash DD slash YYYY

Surgical Consent Form

Consent 1

Consent 2

Contact Info

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