Animal Clinic of Walla Walla

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  • Home
    • PDF Forms
  • About Us
  • Services
    • Preventive Care
    • Dentistry
    • Surgery
    • Laboratory
    • Diagnostic Imaging
    • Pharmacy
    • Boarding
    • Emergency
    • End of Life Care
  • Our Team
    • Veterinarians
    • Licensed Veterinary Technician
    • Veterinary Assistants
    • Client Services
  • Contact Us
    • New Clients
  • Vetsource

Surgery And Dentistry Consent Form

"*" indicates required fields

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ANIMAL CLINIC OF WALLA WALLA

2089 Taumarson Road
Walla Walla, WA 99362
Phone (509) 525-6111 Fax (509) 525-6102
info@animalclinicww.com

Bret K. Smith, DVM
Alexandra Colton-Ashcraft, DVM
Daniel Prendiville, DVM

MM slash DD slash YYYY
The clinic must have verification of your pet’s vaccination status.
If your pet is found to have transmissible conditions such as fleas, ticks, ear mites, or fungal infections, the clinic must treat such conditions to prevent spread to other patients. Admission of your pet to the hospital constitutes permission for treatment of such transmissible conditions and acceptance of financial responsibility for such treatment.
Do you have any questions or concerns to discuss with the medical staff?
I give my consent and accept financial responsibility for the above-listed procedure(s). Even though animals are given a preprocedure exam, I understand that there are risks involved in the administration of general anesthesia and in performing all surgeries, and therefore I give my permission for treatment of unforeseen conditions which may arise during anesthesia, surgery, and recovery.
My method of payment today will be:*
Clear Signature

TO BE COMPLETED BY HOSPITAL STAFF:

Has your pet eaten today?
Have you noticed any vomiting, diarrhea, and/or coughing during the past 7 days?
Is your pet on any medication?
Does your pet have a history of allergic reactions to any medications?
Has your pet been anesthetized in the past?
Did your pet have any complications during or following the anesthesia?
May we perform pre-anesthesia bloodwork today?
May we administer peri-operative fluids?
May we administer peri-operative fluids?
Would you like to have your pet Microchipped ?
Clear Signature

© Animal Clinic of Walla Walla 2025

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