Complete your Surgical Consultation form online! Please enable JavaScript in your browser to complete this form.Owner's Name *FirstLastEmail *Phone *Patient's Name *I hereby authorize a TSVS surgeon (and his/her designated associates or assistants) to perform a consultation on my pet alongside my primary veterinary facility. The nature of the procedure(s) has been explained to me and no guarantee has been made as to results or cure. *I authorize.I consent to the administration of such anesthetics or tranquilizers if necessary to complete a thorough examination on my pet. *I authorize.Anesthetic Risks: (Although every effort is made to make anesthesia as safe as possible including vital sign monitoring and use of the most up to date anesthetic agents and equipment, understand that anesthesia has inherent risks). We do not anticipate any in your pet but, on occasion, the following can occur: 1. Allergic reaction to the anesthetic agents 2. Heart rhythm abnormalities 3. Untoward reactions to the gas including drops in blood pressure or respiratory difficulties 4. Just like in humans, on very rare occasions, general anesthesia can result in death. *I have read and understand the risks.I understand there will be a fee incurred for such examination of my pet. The fee will range between $165.00- $385.00. If TSVS is at my primary veterinary hospital for a surgical procedure on another pet on the same day, the fee assessed for the consultation will be $165.00. If TSVS visits my primary veterinary hospital to examine my pet only, the fee will be $385.00. If the consultation is booked with TSVS along with another surgical procedure, it is up to my primary veterinarian’s office to inform me if the surgery cancels and the fee incurred for the consultation will increase to $385.00. I am welcome to reschedule the consultation for another day TSVS will be at the hospital for a surgical procedure to decrease the consultation fee. * If TSVS has previously performed surgery, and this is a recheck exam, a fee of $75.00-$150.00 could be charged at the TSVS surgeon’s discretion. Fees incurred for sedation, radiographs, etc. will be an additional charge from the hospital. *I have read and acknowledged the fees.I authorize and understand by verbal consent and written consent the above information. *I authorize and consent.Owner's Signature * Clear Signature NameSubmit
