Fraser Valley Animal Hospital

2633 Ware Street
Abbotsford, BC V2S 3E2


Surgery Consent Form

Client Name

Contact Phone
Phone TypePhone Number
Alternative Phone
Phone TypePhone Number
Patient Name

Today's Weight


Estimate given?


Estimate given ($)

⦁ I am the owner, or authorized agent for the owner, of the patient identified above. I have the authority to give authorization and do so voluntarily. ⦁ The procedures identified above have been explained (the purpose for performing them and the risks involved with them) to my satisfaction. I realize that there can be no guarantee as the patient’s condition or outcome of any procedures. In particular, I have been advised that, in the event that the treatment requires the use of anesthesia, that there is a risk of death every time an anesthetic is used and that I have been advised of the likelihood of such occurrence. I authorize the performance of the identified procedures and the use of the associated anesthetics and other medications as indicated. ⦁ I understand that unforeseen conditions may be revealed during the identified procedures, which, in the opinion of the attending veterinary, require more extensive or different procedures/treatments. I understand that all efforts will be employed to obtain my instructions regarding them however, if the efforts are unsuccessful, I authorize the performance of any procedures or treatments, whichever are necessary in the professional opinion of the attending veterinarian. ⦁ I authorize oral administration and associated charges of CAPSTAR if fleas are seen on my pet during the pre-surgical examination. (At a cost of $ 10.00) ⦁ I understand that I have given a phone number at which I can be contacted during surgery if there is an emergency or if any questions arise. I am aware that if any additional procedures are found, but are not medically necessary AND I am unavailable to give consent, that FVAH cannot do the procedure. This means that the additional items will have to be done as part of a second surgery, that is wholly at my own cost. ⦁ If I have declined vaccinations, I understand that my pet is not protected against virus and disease.
I have read and understand this authorization. (Initials/Signature) (required)

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