Client Consent Form

Please fill out this form as completely and accurately as possible.

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Client Consent

If you have any questions, please feel free to email us at [email protected].

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Client's Name *

First

Last

Patient's Name *

Phone *

Today's Date *

Email *

Referral Hospital

Attending Veterinarian

First

Last

I, as the owner or party responsible for the above pet hereby authorize the doctors and staff of Palmetto Veterinary Specialist, LLC to perform the following procedure(s): *

Procedure *

On the

Left
Right
Both
Non-applicable

I understand that anesthesia will need to be administered to accomplish the surgical procedures. It has been explained to me that conditions may arise during this procedure whereby a different or additional procedure may need to be performed. I understand that all efforts will be made to contact me prior to such procedures being performed, but there may be instances where it is in the best interest of my pet to proceed without delay. *

I have read and understand

I have been advised as to the nature of the procedure(s) and the inherent risks involved. I understand that complications, including but not limited to infection, hemorrhage, implant failure, cardiac arrest, and death, could result. I acknowledge that no guarantee has been made as to the result or cure. I understand the follow-up care will primarily be with the attending veterinarian. *

I have read and understand

Palmetto Veterinary Specialist, LLC occasionally features patients on their Facebook, Instagram, YouTube, or other social media sites and in publication (print or online). With your permission, we may share your pet’s picture, video or story. We may mention your pet’s name but never your last name. Dr. Morrison and staff would be grateful that you’ll be helping other pets by educating pet owners, veterinarians, and veterinary technicians. *

I give permission
I do not give permission

Client Consent Form

Client Consent

Appointment

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Veterinary Care Partners