Surgery Drop-Off Questionnaire

APPOINTMENT

Surgery Drop-Off Questionnaire

Please complete the form below prior to your appointment.

Additional services requested:
I hereby authorize The Cat Doctor of Monroe and Dr. Kimberly Scutchfield to use sedation and/or general anesthesia on my pet. I understand that sedation and anesthesia pose a risk to my pet, regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. As the owner or appointed caregiver, I understand that by signing below, I agree to pay for all charges +/-15% of the fees for my pet’s procedure and will pay the balance in full upon discharge of my pet. The sedation and/or anesthesia and relevant procedure costs have been fully explained to me to my satisfaction.
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