Anesthesia | Surgery Consent Form

*Your Name:

*Your Email:

*Your Phone Number:

*Pet's Name:

*Pet's Breed:

*Surgery/Procedure:

*When Was the Last Time Your Pet Ate?

Home Again Microchip

A microchip is a permanent form of identification which will help identify and return your pet should they get lost or stolen. The chip is about the size of a grain of rice will not cause your pet any discomfort. The microchip plus a lifetime enrollment with HomeAgain® is $39.95

 I am the owner or authorized agent of the above-named pet and hereby consent and authorize the above procedure(s) to be performed. I understand that there is always a risk associated with any anesthetic procedure, even in apparently healthy animals, and that results cannot be guaranteed. I also understand that it may be necessary to provide medical and/or surgical services which may not have been anticipated for the safety and/or care of my pet. I agree to be held responsible for any charges incurred while my pet is in the care of Bark Avenue Animal Hospital. I understand that payment is due at the =me my pet is released from the hospital

 I UNDERSTAND AND ACKNOWLEDGE THAT HOSPITAL STAFF IS NOT IN ATTENDANCE AFTER REGULAR BUSINESS HOURS