Patient Drop Off & Consent Form – Surgery

We will call you as soon as your pet has been seen and treatment has been provided. The doctor or technician will call you prior to performing any additional diagnostic testing or treatment that the doctor believes may be needed.

We will honor to keep charges in line with any estimate given. However, unforeseen situations may arise. If the need arises, we will call to inform you of any additional charges that may be required prior to performing the service. If we cannot reach you, and a procedure needs to be performed for the health and safety of the animal, it will be done, and charges will appear on your bill. Pets that are hospitalized on an emergency basis will require a deposit for treatments based on an initial assessment. Extensive hospitalized stays may require keeping charges current prior to expected discharge. Payment for all the services rendered is due at the time of discharge.

All pets that are admitted into the hospital are required to be current on all vaccinations; parasite checks and physical exams prior to a surgical procedure. All admitted pets must be free of external parasites. Animals with fleas or ticks present will be administered a preventative at the owner’s expense.

We at the Bensenville Animal Hospital strive to ensure that your pet receives the safest and most up-to-date medical care. However, unforeseen complications can and do occasionally arise during or after a procedure. In the event my pet experiences a cardiac, respiratory, or other life-threatening emergency that requires resuscitative or other urgent care measures, such as cardiopulmonary resuscitation (CPR), emergency drugs, or other similar measures, I request that the veterinarians and/or trained staff at Bensenville Animal Hospital pursue treatment as indicated below.

I, the undersigned owner or agent of the owner, certify that I am eighteen years of age or over and authorize the veterinarian(s) at this practice to perform the above procedure(s). I understand that I am encouraged to discuss any concerns or questions about any medical risks with the doctor before any exam/procedure is initiated. I understand that medical treatments, including anesthesia, are not without risks. Your signature below signifies understanding of the above and authorizes the attending veterinarian to perform the procedures listed as well as any emergency treatment that may become necessary. Your signature also releases Bensenville Animal Hospital of any liability associated with the treatment of your pet both during and after service rendered.

I understand that if my pet requires overnight round-the-clock specialty or emergency care, I may be referred to a 24-hour emergency veterinary hospital and my pet will require owner-provided transportation prior to the end of day at Bensenville Animal Hospital.