COVID-19 Response - We're Open!

Consent for Surgery

Thank you for giving Gateway Veterinary Services the opportunity to care for your pet(s). During this time, we are asking all clients to fill this out prior to their pet’s appointment.

Please note: In order to schedule an appointment, please call our team or click here. Please schedule your appointment prior to completing the form below.

I hereby certify that I am the owner or authorized agent for my animal, and I consent for Gateway Veterinary Services Prof. Corp. and the staff to perform the procedures as presented to me on this date. I give them permission to do all that they deem necessary as laid out in this treatment plan presented to me and as medically required for my animal.

I have been notified of the risks taken when undergoing general anesthetic. The nature of such service has been described to me to my satisfaction and I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure.

The policy at Gateway Veterinary Services Prof. Corp. is that all animals be fully and properly vaccinated prior to undergoing any procedure or stay at the hospital. Should I refuse vaccinations or not be properly vaccinated prior to treatments, any illness my animals happen to become infected with are solely my responsibility, and I release Gateway Veterinary Services Prof. Corp. from any liability.

Gateway Vet Services will not go over the estimated total by more than $50 without consent from you, the owner/authorized agent. This patient treatment plan may not include all medications required for home care in the case of extended pain management or antibiotics.

Be assured that the health of your animal is our highest concern and we will do everything possible to maintain that health. Understand that your signature below indicates that you have reviewed and agree to the terms of this treatment plan. If you have any questions concerning this treatment plan, please ask prior to signing this document.

I understand that I assume financial responsibility for all services rendered, and that payment is due upon completion of services.

I accept and agree to the terms of this patient treatment plan:

MM slash DD slash YYYY
Estimate Review Performed by:(Required)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.