General Anesthesia Consent in Sunnyvale, CA

Name
First Last
Date
Chart #*
Species Age Sex Weight
Phone 1*
Phone 2
Owner Name
First Last
I understand every effort will be made to contact me and if I am unreachable my pet’s services may not be performed/completed in their entirety which could result in repeat visits and additional fees.
Treatment Recommended
When did your pet last eat?*
Is your pet sick?*
What medications is your pet receiving at home?*
What medications is your pet receiving at home?*
Has your pet been scratching, itching or scooting?*
Would you like photo updates?*
We can post pre & post procedure updates to our social media pages so you may view, comment and share.
I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do herby authorize Murphy Avenue Pet Clinic to provide care and perform treatment up-to and including diagnostic bloodwork, x-rays, vaccines, medications and administration of medical procedures they consider reasonable and necessary for my animal’s health, safety and comfort. I understand that with any medical procedure there are always risks involved, including death, and that no warranty or guarantee is being made as to the results or cure. I understand additional charges will accrue if my animal is not picked up before the hospital closes on the day he or she is ready to be released from the hospital. I understand payment in full is expected at the time of pick up and I assume full responsibility for all fees associated with the veterinary services provided
Signature
Owner Type Name