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Surgical/Anesthetic Consent Form

Have an appointment coming up with us? Save time in the clinic and fill out the necessary forms online. Your information will be sent securely to us and we’ll be ready to check you in as soon as you arrive! If you have any questions or concerns, please contact us at 252-355-7504.

Winterville Animal Care Surgical Anesthetic Consent Form

Surgical/Anesthetic Consent Form

I, the undersigned owner, or agent of the pet identified above, authorize the staff of Winterville Animal Care to perform the previously discussed procedure.


I have been advised of the nature of the services and procedures to be performed, as well as the risks involved.  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 failure to comply with the aftercare instructions.


I understand that some risks always exist with anesthesia/sedation and surgical procedures. I understand that the attending veterinarian will make every effort to contact me regarding the treatment in the case of unforeseen emergencies.