# 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. 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. Canonical: https://reuily.com/templates/veterinary-surgery-consent-form Use this template: https://reuily.com/form/from-template/veterinary-surgery-consent-form Collections: Agreements & Waivers, Pets & Animals, Veterinary Clinics Last updated: 2026-10-24 ## Questions - Question 1: What's your full name? (Short Text, required) - Question 2: What's your email address? (Email, required) - Question 3: What's the best phone number to reach you on surgery day? (Phone, required) - Question 4: What's your pet's name? (Short Text, required) - Question 5: What's your pet's species and breed? (Short Text, required) - Question 6: Which procedure is your pet having? (Short Text, required) - Question 7: When is the procedure? (Date, required) - Question 8: When did your pet last eat? (Short Text, required) - Question 9: Has your pet been sick or had any changes in the last week? (Yes / No, required) - Question 10: Describe any changes (Long Text, optional) - Question 11: Would you like bloodwork before anesthesia? (Single Choice, required). Options: Yes, run bloodwork first; No, I decline bloodwork - Question 12: Which optional care would you like while your pet is under anesthesia? (Multiple Choice, optional). Options: Microchip; Nail trim; Ear cleaning; Vaccines that are due; IV fluids - Question 13: If we find something unexpected and can't reach you, what should we do? (Single Choice, required). Options: 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 - Agreement: Surgery and anesthesia consent, accepted with "I agree" (full text below) - Question 14: Sign the surgery consent (Signature, required) Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy. ## Surgery and anesthesia consent Please read this before you sign. This consent is between **[Clinic name]** (the "Clinic") and the owner named in this form. 1. **Owner.** I am the owner of the pet named above, or I am authorized to make decisions for the owner. 2. **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. 3. **Anesthesia risk.** I understand every anesthetic carries some risk, including rare serious problems or death, even in healthy pets. 4. **Estimate.** I have received an estimate of **[estimate amount]**. The Clinic will try to call me before going more than **[percent]** percent over it. 5. **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. 6. **Fees.** I agree to pay for the services my pet receives at pick up, under the Clinic's payment policy. 7. **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. ## 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 ## 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.