Veterinary Surgery Consent Form

Veterinary surgery consent forms are used by veterinarians to get permission from animal owners to treat and operate on their animals.

Eligibility

The person who fills out the consent form should be the owner of the animal. If the person is not the owner, the owner should have given him/her the permission to do so.

Not the Template you are looking for?
Request new template
Not the Template you are looking for?
Request new template

Questions for Veterinary Surgery Consent Form

1.

Owner's Name

The answer should be a text input.
2.

Phone Number

The answer should be a phone number.
3.

Address

The answer should be a text input.
4.

Has your pet been seen by a veterinarian in the last 6 months?

The answer should be a single choice:
  1. Yes
  2. No
5.

Is your pet up to date on vaccinations?

The answer should be a single choice:
  1. Yes
  2. No
6.

Is your pet on any medications?

The answer should be a single choice:
  1. Yes
  2. No
7.

Does your pet have any known allergies?

The answer should be a single choice:
  1. Yes
  2. No
8.

Does your pet have any known medical conditions?

The answer should be a single choice:
  1. Yes
  2. No
9.

Has your pet ever had surgery before?

The answer should be a text input.
10.

I understand that there are always risks associated with anesthesia and surgery.

The answer should be a single choice:
  1. Yes
  2. No
11.

I understand that I will be required to sign a separate anesthesia consent form prior to the procedure.

The answer should be a single choice:
  1. Yes
  2. No
12.

I hereby authorize the staff of the Veterinary Medical Center to perform the following diagnostic and/or therapeutic procedures on my pet.

The answer should be a single choice:
  1. I agree
  2. I disagree
13.

Client's Signature

The answer should be a signature.

Similar Ideas

  • General Veterinary Surgery Consent Form
  • Spay/Neuter Surgery Consent Form
  • Dental Surgery Consent Form
  • Orthopedic Surgery Consent Form
  • Soft Tissue Surgery Consent Form

Here are some FAQs and additional information
on
Veterinary Surgery Consent Form

What is a Veterinary Surgery Consent Form?

A Veterinary Surgery Consent Form is a document that is used to provide consent for a veterinary surgeon to perform a surgical procedure on an animal. The form will detail the nature of the procedure, the risks involved, and the expected outcome.

Why is a Veterinary Surgery Consent Form necessary?

A Veterinary Surgery Consent Form is necessary in order to protect both the veterinary surgeon and the animal owner. It ensures that the veterinary surgeon has the animal owner's permission to carry out the procedure and that the animal owner is aware of the risks involved.

What information should be included in a Veterinary Surgery Consent Form?

A Veterinary Surgery Consent Form should include the following information: the name and contact details of the veterinary surgeon, the name and contact details of the animal owner, the name and species of the animal, the nature of the procedure, the risks involved, the expected outcome, and the animal owner

Want to use this template?

Loved by people at home
and at work

“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Veterinary Surgery Consent Form

1000+ Templates, 50+ Integrations

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE