Consent Form

Fill out the form before your pet’s surgery for a smoother visit at our hospital!

San Juan Vet Hospital Consent Form

Please fill out the form below as completely & as accurately as possible so that we may better assist you. We look forward to seeing you soon!

Client Name *

First

Last

Email *

Patient Name *

Phone number at which owner can be reached today or tomorrow: *

Additional number

Before Procedure:

Would you like to be contacted before your pet goes in for the procedure *

Would you like to be contacted by text or phone call before the procedure? *

Text
Call
Either

If text, what number would you like to be texted at?

After procedure:

Would you like us to text you after the procedure, or would you prefer a call? *

Text
Call

Anesthetic and surgical procedure(s) to be performed: *

I, the undersigned owner or agent of the pet identified above, authorize the staff of Lake Road Animal Hospital to perform the above procedure(s). *

I have read and agree

Microchip: *There is an additional fee for this procedure* *

Yes
No
Already has one

Nail Trim: Would you like a complimentary nail trim for your pet? *

Have you given your pets any medications or supplements in the past week? *

Presurgical Pack
Carprofen
Meloxidyl
Other (please specify below)
None

Other medication(s), please specify and note last time given

When was the last time fed?

Any other concerns/allergies/procedures?

I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. *

I have read and agree

I am over 18 and understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures. *

I give my permission [yes]
I do not give my permission [no]

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above. *

I have read and agree

I certify that I am 18 years of age or older and responsible for the financial and medical decisions for the above mentioned pet. *

I agree
I disagree

Please type initials below *

Date *

Comment

We proudly serve the pets of Pagosa Springs, CO and beyond

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet’s first adventure throughout a long and healthy life.

Contact Us

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Location

2197 E Hwy 160
Pagosa Springs, CO 81147

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Contact Information

Phone: 970-264-2629
Email: [email protected]

Day

Hours

Monday - Friday

8:00 AM - 5:00 PM

Saturday

Closed

Sunday

Closed

Questions?

We’re here to help.

If you need anything at all for your pet, please use the information below to contact us. A member of our team will be in touch soon!

Name *

First

Last

Email *

Phone

How can we help you? *

Comment