Surgery Consent Form

Welcome to Tchefuncte Animal Hospital! Fill out our Surgery Consent Form below.

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Tchefuncte Animal Hospital Surgery Consent Form

Please fill out our Surgery Consent Form below as accurately as possible.

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Pet Information

Pet's Name *

Contact Information

Owner's Name *

First

Last

Email *

Phone *

Additional Phone

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is: (example: lump removal, exam, etc.) *

Please specify where the lumps are located *

While sedated, would you like for a microchip to be placed in your pet to aid in identification in case he/she is lost ($10 off regular microchip price if done concurrently with another procedure)

Authorization

I hereby consent and authorize the doctor(s) at Tchefuncte Animal Hospital, LLC to perform upon my pet the procedure(s) mentioned above. *

I have read, understand, and authorize

Potential complications, while rare, can include swelling, delayed healing, infection, and rarely, death. To minimize the risk of complications, please be prepared to follow all post-operative discharge instructions including keeping your pet confined, administering all medications as directed, and ensuring your pet is eating, drinking, urinating, and defecating normally. If sutures are present, an E-collar may be sent home with your pet to help prevent licking. Please ensure your pet wears it for 10 days post-op. I authorize the use of professionally accepted general anesthesia to perform this surgery as deemed necessary by the doctor(s). I understand that support personnel will be used as needed by the veterinarian. I have been advised as the nature of the above procedures and the risks involved in performing general anesthesia to the above animal. I realize that results cannot be guaranteed. I understand that most medical and surgical procedures are accompanied by © some risks (including death), especially when anesthesia is used. If an emergency arises, I give the doctors and support personnel permission to do whatever they deem necessary to handle the emergency. I expect to be notified of any problems as soon as comfortably possible if they arise. I have read and understand this authorization and consent. I further understand that I assume full financial responsibility for all services rendered. *

I have read, understand, and authorize

Date *

We proudly serve the pets in Madisonville, LA, and beyond.

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care. We see patients from communities all over, including Covington, Mandeville, and St. Tammany Parish.

Surgery Consent Form

Tchefuncte Animal Hospital Surgery Consent Form

Pet Information

Contact Information

Authorization

We proudly serve the pets in Madisonville, LA, and beyond.

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