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Desert Ridge Animal Hospital

Surgery & Sedation Consent

Surgery & Sedation Consent Form

Please complete the form below, and a member of our team will get back to you if we have any questions. Thank you!

Client Name *

First

Last

Email *

Patient Name *

Phone number at which you can be reached during the procedure? *

Additional number that you can be reached 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: *

Dental procedure
Surgery
Ultrasound or Echocardiogram

Please select one: *

Please remove and extract all disease teeth at the doctor’s discretion (Charges for all extraction will be incurred).
Please contact me prior to doing any advanced dental work on my pet including any extractions or removal of diseased teeth.

Surgical procedure(s) to be performed: *

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

I have read and agree.

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

Yes
No
My pet already has one

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

Yes, please specify below
No

Please specify and note the last time given:

I am not to feed my pet after 10pm the night before the procedure. *

I have read and agree.

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 understand that some risks always exist with sedation 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]

I have been provided an estimated cost for the procedure(s) listed above. *

Yes
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 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.

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 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.

Date *

Phone

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Call Us!

If you'd like to get in contact with us quickly, call us at 480-618-5333. We'd be happy to answer any of your questions.

How Can We Help?

Please don’t hesitate to reach out by using the contact information or online form below.

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Location

5415 E High St, Suite 137
Phoenix, AZ 85054

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Contact

Call or text: 480-618-5333

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Hours

Monday - Friday: 7:30 am - 6:00 pm

Name *

First

Last

Email *

Phone

How can we help you? *

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