Veterinary Surgery Consent Form Template
A free sample veterinary surgery and anesthesia consent form. Owners confirm the procedure, choose optional care and sign online before drop off.
Customize the pages and design to fit your needs.
About this template
Owners confirm their pet, the procedure, fasting and an emergency phone number, then choose optional bloodwork and add on care. They sign the surgery and anesthesia consent online and you keep a signed PDF in the record.
Common uses
- Spays, neuters and dental cleanings
- Vet clinics before drop off
- Mobile and mixed practice surgery days
Key features
- Fasting and recent health questions
- Bloodwork and add on choices
- Signed PDF for the record
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's the best phone number to reach you on surgery day?
Phone
What's your pet's name?
Short Text
What's your pet's species and breed?
Short Text
Which procedure is your pet having?
Short Text
When is the procedure?
Date
When did your pet last eat?
Short Text
Has your pet been sick or had any changes in the last week?
Yes / No
Describe any changes
Long Text · Optional
Would you like bloodwork before anesthesia?
Single Choice · Yes, run bloodwork first, No, I decline bloodwork
Which optional care would you like while your pet is under anesthesia?
Multiple Choice · Optional · Microchip, Nail trim, Ear cleaning, Vaccines that are due, IV fluids
If we find something unexpected and can't reach you, what should we do?
Single Choice · Treat it if it costs up to the amount in my estimate, Only do the planned procedure, Keep trying to reach me before doing anything else
Surgery and anesthesia consent
Agreement text, accepted with “I agree”
Sign the surgery consent
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Surgery and anesthesia consent
Signers read this text in the form before they accept it. Edit the bracketed details to match your business, and have the wording reviewed for your situation.
Please read this before you sign.
This consent is between [Clinic name] (the "Clinic") and the owner named in this form.
- Owner. I am the owner of the pet named above, or I am authorized to make decisions for the owner.
- Procedure. I authorize the Clinic's veterinarians and staff to perform the procedure listed above, along with the anesthesia, pain relief and care it needs.
- Anesthesia risk. I understand every anesthetic carries some risk, including rare serious problems or death, even in healthy pets.
- Estimate. I have received an estimate of [estimate amount]. The Clinic will try to call me before going more than [percent] percent over it.
- Emergencies. If my pet needs emergency care during the procedure, I authorize the Clinic to give it and to follow my choice above for unexpected findings.
- Fees. I agree to pay for the services my pet receives at pick up, under the Clinic's payment policy.
- Results. No guarantee has been made about the result of the procedure.
By signing below, I confirm that the information in this form is true and I consent to the procedure and anesthesia.
Frequently asked questions
What should a veterinary surgery consent form cover?
The pet and procedure, fasting, recent health changes, anesthesia risk, bloodwork, optional care, an estimate, emergency care and what to do with unexpected findings.
Does it include anesthesia consent?
Yes. The consent covers both the procedure and anesthesia, with a choice to accept or decline bloodwork first. It's a sample to start from, not legal advice.
Can owners sign before they arrive?
Yes. Send the link the day before, and the signed consent is saved as a PDF with an audit trail you can add to the record.