"*" indicates required fields NameThis field is for validation purposes and should be left unchanged.Patient Name*Owner's Name* First Last I hereby entrust All Cats Hospital, LLC (ACH) to care for my cat during his/her surgery stay. I am the owner, or a representative of the owner, of the animal presented and have the authority to execute this consent. I have been advised as to the nature of the procedure to be performed and the risks involved. I understand the doctors and staff will use all reasonable precaution against the injury and/or death of my cat, and I hereby consent and authorize this hospital to perform the requested anesthesia and surgical procedures. In the event of unforeseen complications, I give permission to the doctors and staff to take reasonable measures in treating my cat and accept all charges that are incurred as a result of such action. I understand that I must furnish phone numbers) where ACH can reach either me or a contact person whom I have authorized to make medical decisions.* I have read and understand.Procedures requiring anesthesia are time-sensitive and provide a narrow window of time in which to reach you. For your cat's safety, please list where you or your agent can be reached without delay.Contact PersonPhone Numbers Add RemoveIn the event the authorized contact person is not reachable, would you prefer us to proceed with any additional recommended treatment? Please select your preference:* Yes, please proceed with additional treatment. I understand that there will be additional charges for further treatments. No, please do not proceed with any treatment beyond the initial treatment plan. An exam is required on all cats prior to anesthesia. The pre-anesthetic exam is complimentary on cats examined within the previous 3 months. I understand that if my cat has not been examined by a veterinarian at ACH within the previous 3 months, there will be an additional exam fee.* I have read and understand.Bloodwork is required within 30 days of an anesthetic procedure. If bloodwork has not been done within the past 30 days, then it will be performed today for an additional fee.* I have read and understand.I understand that the safety of my cat is the overriding priority. I understand that any price quote I have been given is an estimate and if complications are involved, or the procedure is of greater dimensions than anticipated, the price may be higher. I understand that by signing below, I agree to pay for all charges incurred as such and will pay the balance in full upon discharge of my cat.* I have read and understand.PAIN CONTROLPain control is imperative after surgical procedures. You have an option of a long-acting opioid topical that lasts for 4 days that lasts for 3 days or an oral opioid medication. Your cat may also receive an anti- inflammatory injection. Please select your preference: Zorbium- a long acting (4 days) topical application of buprenorphine. Possible side effects are hyperactivity, sleeplessness, paranoia and agitation. Transmucosal Buprenorphine - a twice daily oral medication. Side effects are possible but less likely since lower doses are given more frequently. Printed Name* First Last Signature*Date* MM slash DD slash YYYY
