Surgery / Anesthesia Consent Form

Please fill out the following form before your scheduled surgical appointment. If you have any questions, do not hesitate to give us a call at 610-793-2589. Please Note: All * fields are required.

Anesthesia/Surgical Consent


I, the undersigned owner or agent of the pet identified above, authorize the staff of Lenape Veterinary Clinic to perform the above procedure(s).


I understand that some risks always exist with anesthesia/sedation and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.

CPR (Cardio Pulmonary Resusitation)


I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life-sustaining procedures.

While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.


I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow-up radiographs, re-check physical exams, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.


A complete physical exam will be performed on your pet prior to the surgical procedure. However, this may not identify all systemic or metabolic problems. For this reason, your pet will have a pre-anesthetic blood panel to evaluate major organ functions prior to anesthesia.


I have read and fully understand the terms and conditions set forth above.

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