Surgical Check-In

Name(Required)
MM slash DD slash YYYY
Has your pet experienced any changes in urination or defecation?(Required)
Has your pet experienced any changes in behavior?(Required)

I, the undersigned owner or agent of the owner of the pet identified above, certify that I am eighteen years of age or older and authorize Sharp Pet Hospital to perform the above 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 is to be initiated. My signature on this form indicates that any questions I have regarding the following issues have been answered to my satisfaction:

  • The reasonable medical and/or surgical options for my pet
  • Sufficient details of the procedures to understand what will be performed
  • How fully my pet will recover and how long it will take
  • The most common and serious complications
  • The length and type of follow-up care and home restraint required
  • The estimate of the fees for all services
  • Any necessary payment arrangements

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 agree to financial responsibility for the remaining fees and will provide payment via cash or credit card at the time my pet is discharged from the hospital.

(Required)
Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me, select the following answer:(Required)