GAVC Spay/Neuter/Surgery Questionnaire-

Please fill this form out ONLY if you have a scheduled surgery.

First and Last Name *

Pet's Name *

Date and time of your surgery *

dd-MMM-yyyy HH:MM AM/PM

Best Number to Reach You On Day of Surgery *

Can we text this number with updates, instructions, etc? *

What type of surgery? *

Please list the diagnostic tests done for THIS surgery (ex. bloodwork, xray, etc.)

Does your pet have any major health issues? If so, please explain.

Please list any medications your pet is on and when last given.

Is Your Pet Up-to-Date on Vaccinations?

Please upload your pet's medical records/diagnostic tests if you have them:

IMPORTANT: If you do not have your pet's medical records/diagnostic tests on hand, please have your vet e-mail them to info@gavccolorado.com or please bring a copy when you come for your appointment.

Please visit our pricing page for info on all of our pricing:

GAVC Pricing

CPR

In the event that my pet should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitation efforts to be initiated until you can be contacted further and notified of your pet’s status?

By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion.

Our office closes at 5:00pm. Any pet that is picked up after 5:00pm is subject to a $25.00 per half hour late charge, due at the time of pick-up. *

Check to acknowledge above

Consent for treatment and surgery

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.

I authorize the staff of Guardian Angel Veterinary Care to treat my pet as they deem necessary. I understand that there can be unforeseen risks associated with this treatment and that there may be medical or surgical procedures that are not anticipated but are necessary for the safety of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian's professional judgment. I accept responsibility for any result in additional charges.

I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful outcomes. I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital.

I understand that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure and that the risks/complications have been explained to me. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated.

I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication.

I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I accept that my financial obligations remain regardless of the outcome.

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment and surgery.

Date *

GAVC Spay/Neuter/Surgery Questionnaire-

Add-on Services

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