ACC Surgery Consent Form



Owner Information:

Owner's Name: Phone:

Address: City:

State: Zip:

Email Address:

Description of Cat:

Sex: Age: Name of Cat:

Breed: If Other :

I am the owner, or the agent for the owner, of the previously described animal and
hereby authorize the relevant surgeries/procedures.

I also authorize the use of appropriate anesthetics and other medications,
and understand that clinic support personnel will be employed as deemed
necessary by the veterinarian.

I understand that, during surgery, unforeseen conditions may be revealed that
necessitate a modification of procedure. Therefore, I hereby authorize any procedures
that, in the veterinarian's professional judgment, are deemed necessary.

I am aware that all surgeries and anesthesia pose some inherent risk of complication.
I accept that, although the veterinarian tries to minimize those risks, not all are avoidable.

I have been advised as to the nature of the procedure(s) and the risks involved. I realize that
results cannot be guaranteed.

I understand that it is my responsibility to pick up my cat at the designated time. I agree to
pay a $10.00 fee for my late pick-up (unless previously arranged) or an overnight stay.
I also understand that if I have not picked up my cat within 24 hours, I can be
charged with abandonment under New York State Law.

I understand that I will not receive a refund if I miss this appointment.

I have read and understand this authorization consent.

I agree to and accept all the above: