Surgery / Dental Consent Form | Carter County Animal Hospital

At Carter County Animal Hospital, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

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Comments

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Date

Name*

First Name Last Name

Address*

Street Address City State / Province / Region ZIP / Postal Code

Home Phone*

Please enter a valid phone number.

Work Phone

Please enter a valid phone number.

Pet's Name*

Breed

Color

Age

Sex

I, being responsible for the above described animal, have the authority to grant you my consent to receive, prescribe for, treat and/or operate upon my pet. I understand that once I bring my pet home from the hospital I am responsible for the after care of my pet and will be monetarily responsible for any complications that arise post-surgery away from the hospital. I understand the surgery or treatment contemplated is:

Surgery/Treatment Description*

After carefully reading the above, I have signed in agreement

Owner or Responsible Party*

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