Client Information

Owner’s Full Name

Email *

Primary Phone Number *

Secondary Phone Number

Species

Dog
Cat

Pet's Name *

Breed

Age or Date of Birth *

Sex

Male
Neutered Male
Female
Spayed Female

Procedure Information

Scheduled Surgery

(Please list the specific procedure scheduled for your pet)

Date of Scheduled Surgery *

Anesthesia & Monitoring

Your pet will be placed under general anesthesia to ensure a safe and pain-free surgical experience. Anesthesia is administered and monitored by our trained veterinary team throughout the procedure.

While every effort is made to minimize risk, anesthesia carries inherent risks—particularly for pets who are elderly, have underlying health conditions, or are undergoing lengthy procedures. To reduce these risks, we perform pre-anesthetic bloodwork and monitor vital signs (heart rate, blood pressure, oxygen levels, etc.) continuously during surgery.

Please indicate your choice below:

I consent to anesthesia for my pet as part of the surgical procedure.
I decline anesthesia and understand that without it, the scheduled procedure cannot be performed.

Pre-Anesthetic Bloodwork (Required for pets over 7 years of age)

Pre-surgical blood testing helps us assess liver and kidney function and identify hidden conditions that could affect anesthesia safety.

I authorize pre-anesthetic bloodwork.
My pet has already had bloodwork performed within the past 30 days at another clinic (documentation required).
I decline bloodwork and accept all associated risks.

File Upload

Click or drag a file to this area to upload.

IV Catheter and Fluids

Accept
Decline

IV catheter and fluids are important during anesthesia to maintain tissue perfusion and oxygen delivery, ensuring adequate circulation and preventing organ dysfunction. They also provide a pathway for administering drugs and correcting fluid and electrolyte imbalances.

Surgical Consent

I authorize the veterinarians at Desert East Animal Hospital to perform the surgical procedure listed above and to provide any necessary supportive or emergency care for my pet while under their supervision.

Signature *

Clear Signature

Date *

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Surgery Consent Form

Surgical Consent & Authorization

Client Information

Procedure Information

Anesthesia & Monitoring

Pre-Anesthetic Bloodwork (Required for pets over 7 years of age)

Surgical Consent

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Location

Hours

Contact Information

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