Surgical Consent Form


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You can easily fill out your Surgical Consent Form online and submit it to us with the click of a button.



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Pet Owner Information

Please be available in case we need to get in touch with you.
Pet Owner's Name*
Emergency Contact:*

Pet Information

Before your pet undergoes surgery, it will be examined for any problems that could interfere with anesthesia to avoid risks such as cardiac and/or respiratory arrest.

Just like humans, your pet will have a pre-anesthetic blood test performed prior to any surgical procedure. Our pre-anesthetic screening consists of blood chemistries that check for disorders of the liver, kidneys, blood sugar levels, protein levels and other disease processes as well as complete blood count (CBC) which checks levels of white and red blood cells, platelets, and electrolytes.

For our more mature patients (6 years of age and over) and for any pets with chronic health problems, we may recommend more extensive medical tests to evaluate the safety of anesthetics and surgery.

If your pet is found to have fleas or other external parasites, your pet will be treated before entering surgery, at your expense. This will be done to ensure a sterile surgery environment as well as controlling fleas in hospital environment.


Please select either Yes or No for the following.
Therapy laser is a painless procedure that helps stimulate tissue regeneration and promotes cell growth. This will result in both decreased healing times and decreased pain for your pet.
Provides peace of mind that if your pet is ever lost he/she has a permanent, lifetime ID implanted in them so they can be linked to you and get back home. This also includes the first year of registration.
This helps to prevent your pet in possible vomiting after waking up from anesthesia. It also helps their appetite return to normal much faster. Plus, it helps with visceral pain which is pain related to the internal organs in the middle of the body.
This is dependent on neck/nose size of the animal and helps so they can’t reach their incision size resulting in early suture removal.
You’re more than welcome to take your pet home same day of procedure, but we do offer 1 free night stay if you would like. This can be used the day before surgery or the day of.
We make a small green line next to the incision site in case your pet was to ever get lost. This is a universal indicator that the pet has been altered.
I hereby give consent to direct Cypress Creek Animal Hospital to perform the procedure(s) noted above and to administer such treatments, diagnostics, anesthetic and surgical procedures as they deem necessary for my pet.

I have been advised and understand the nature of the procedures as well as the relative risks involved. I authorize Cypress Creek Animal Hospital to provide any appropriate care should an unexpected complication arise.

No guarantee has been given to me as to the result or cure of these procedures. I will not hold Cypress Creek Animal Hospital, its veterinarians, or staff members responsible for any complications that may arise.

Further, I assume financial responsibility for all services rendered/charges incurred to my pet.
Signature of Owner/Agent**
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