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Authorization For Professional Services
Authorization For Professional Services Form
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This field is for validation purposes and should be left unchanged.
Owner's Information
Owner's Name
(Required)
First
Last
Pet's Name
(Required)
Emergency Phone
(Required)
Services
I Hereby Consent To And Authorize The Performance Of The Following Procedure(s):
(Required)
Ovariohysterectomy (Spay)
Castration (Neuter)
Dentistry (+/- Extractions)
Mass Removal
Other
If 'Other', Please Specify:
Would You Like A Microchip For Your Pet Today?
(Required)
Yes
No
Pre-Anesthetic Bloodwork
(Required)
Anesthesia carries inherent risk; disorders of the liver or kidneys may not be readily apparent on physical examination and may increase the risk of adverse events under anesthesia. We recommend the following pre-anesthetic bloodwork to detect any underlying problems with these organs.
Young/Healthy Adult Pet (<7 Years Of Age)
Senior (>7 Years Of Age) Or Sick Pet
I Decline The Recommended Pre-Anesthetic Bloodwork
If your pet’s vaccinations are not current, we require that you update them before or at the time of surgery. Our hospital policy is that all pets must be current on rabies vaccination. Dogs are also required to be current on dhlpp and bordetella (kennel cough). Cats are also required to be current on the FVRCP vaccine.
If your pet is found to have fleas or ticks at the time of surgery, your pet will be treated with flea medication at a cost of up to $40 per pet.
Sedated pets can behave abnormally; it is our policy that all pets stay until completely recovered from sedation and are ambulatory.
If a female pet is found to be pregnant or in heat during a sterilization procedure, there will be an additional charge. If a pet is pregnant, the procedure will continue unless we have been otherwise instructed.
All pets undergoing sterilization surgery (spay or neuter) will have a small tattoo placed at, or adjacent to, the surgery incision as proof of sterilization.
CPR/DNR Consent
In the event that your pet experiences cardiac or respiratory arrest while under anesthesia, please select one of the following options:
(Required)
CPR (Cardiopulmonary Resuscitation): I authorize the veterinary team to perform life-saving measures, including chest compressions, emergency medications, and assisted breathing, in an attempt to revive my pet. I understand that while CPR may restore circulation, it does not guarantee survival or full recovery. Additional costs will apply.
DNR (Do Not Resuscitate): I request that no resuscitation efforts be made if my pet experiences cardiac or respiratory arrest. I understand that this means my pet will pass naturally without intervention
As the owner or authorized agent of the above pet, I hereby consent to and authorize the performance of the procedure(s) and/or service(s) above. I understand that payment is due when service is rendered.
Owner Signature
First
Last
SMS Consent
I agree to receive SMS communications.
I agree to receive recurring automated messages from McDonough Animal Hospital about pet care, appointment reminders, marketing communications, and offers to the mobile number provided. Your consent is not required, and you may opt out at any time by replying STOP. Msg & data rates may apply. Message frequency may vary.
Email Consent
I agree to receive email communications.
I agree to receive marketing offers and updates via your preferred/primary email. You'll still receive services and account related emails if you do not check the box.
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