Surgery Consent Form

By clicking the checkbox below I am providing my consent to the terms described below.

I hereby authorize the Pikes Peak Veterinary Clinic veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that the full amount is due and to be paid at the time of release, and that a deposit may be required for surgical treatment.

I am also aware that unforeseen events resulting from the procedure will not relieve me from any obligation to pay all reasonable costs incurred regarding the animal. I understand that payment is required in full at the time services are rendered.

Please know that our attention is placed on you and your pet while your pet is at Pikes Peak Veterinary Clinic. Occasionally we may miss charges and you are authorizing that we may bill you for any missed charges found within 30 days of your appointment.

I understand that during the performance of these procedures, unforeseen circumstances may be revealed that necessitate an extension or variance in the procedures set forth. I expect Pikes Peak Veterinary Clinic to use reasonable care and judgment in performing the procedures. The nature of the procedures and the risks have been explained to me and I realize results cannot be guaranteed.

I understand that my pet is undergoing an anesthetic procedure. I understand the risks associated with anesthesia and that Pikes Peak Veterinary Clinic will use life-saving measures unless otherwise directed.

I have been given an estimate of costs for the procedure(s) to which I am consenting.