Anesthesia / Surgical Authorization Form

Call us at (614) 836-3222 with any questions when filling out the anesthesia/ surgical authorization form.

Anesthesia / Surgical Authorization Form

Groveport Canal Animal Hospital staff ask that you please wear a mask when we interact with you at your car as we are helping bring in and return your pet to you. It is so important that we stay healthy, so we can continue to help you and your pet.

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Sex
Is your pet

To minimize some of the risks that are involved in surgery, please answer the following questions:

Is your pet on monthly heartworm preventative?

Anesthetic and Surgical Procedures to be Performed

I understand that some risks always exist with anesthesia 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. Since no anesthetic or surgical procedure is trivial or routine, we assure you that your pet will receive a full physical examination prior to anesthesia, and that he/she will be monitored before, during and after the procedure. Regardless of age or health, anesthesia and surgery present a small but real risk to your pet. The doctors choose the safest anesthetic drugs, monitoring equipment and personal attention to minimize these risks as much as possible.

Should my pet require CPR (Cardiopulmonary Resuscitation), including but not limited to cardiac compressions, positive respiration, emergency medications, or other heroic interventions, I consent that the doctors at Groveport Canal Animal Hospital are given my permission to conduct such medical care.

I also understand the following:
- I agree to be financially responsible for all veterinary services provided to my pet while Groveport Canal Animal Hospital team members pursue treatment.
- I understand that regardless of my pet’s recovery or survival I agree to pay the CPR fee in addition to other fees already identified by the practice and agreed upon by me.
- I understand that despite the best efforts of the doctors and team members, CPR may not be successful.

Microchip Implantation

COVID-19 Acknowledgement

For the protection of both our team and clients, have you been exposed to COVID-19 or showing symptoms/signs of COVID-19 in the last 14 days?
You may leave your pets leash, collar, and/or harness on and we will apply our slip leash as well when bringing your dog into the hospital. All cats and pocket pets must be in a carrier for the staff to bring your pet into the hospital.