Portland Veterinary Service

Consent for Treatment Form

Save time during your next appointment! Complete your consent for treatment form online from any device before your visit.

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Consent for Treatment Form

Pet Information

Pet's Name *

Contact Information

Owner's Name *

Email *

Phone *

Additional Phone *

Secondary Contact: *

First

Last

* This person has your authority to consent to medical decisions regarding your pet's surgical care in the event we cannot reach you.

Secondary Contact Phone *

Today's procedure is: (example: lump removal, exam, etc.) *

Additional Services Desired While Patient Is Sedated

Please select any/all that you would like us to provide while your pet is sedated *

Implant Microchip
Clean Ears
Sanitary Clip (rectum, genitals)
Other (specify below)
Nail Trim
Express Anal Glands
Remove Lumps (specify location of lumps below)

Authorization

I authorize anesthesia/sedation for my pet. The nature and risks of this procedure have been explained to me. I understand some risks always exist with anesthesia and/or sedation, and I am encouraged to discuss any concerns I have about those risks with my veterinarian before the procedure(s) are initiated. My signature on this consent form indicates that any questions have been answered to my satisfaction. *

I have read, understand, and authorize

I authorize Portland Veterinary Service to perform any additional diagnostic, treatment, or surgical procedure(s) deemed necessary for medical complications or otherwise unforseen circumstances. I understand there are rare complications associated with any anesthetic procedure. No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures. I fully understand these risks and understand the veterinarians and hospital staff will try to minimize such risks. *

I have read, understand, and authorize

Payment due upon services rendered *

I have read, understand, and agree.

I HAVE READ AND FULLY UNDERSTAND THIS ANESTHESIA CONSENT FORM *

I have read, understand, and agree.

Signature of Responsible Party *

Clear Signature

Today's Date *

Phone

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We proudly serve the pets of Portland, Eagle, Mulliken, Grand Ledge, Pewamo Westphalia, Lyons, Muir, Sunfield, Ionia, Lake Odessa, Clarksville, Saranac, Charlotte, Vermontville, Woodland, and surrounding areas. We look forward to seeing you and your pet. Book an appointment by clicking the button below.

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Have Questions?

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Location

9761 E. Grand River Ave.
Portland, Mi. 48875

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Contact Information

Phone: 989-985-0049
Sms: 517-647-4119
Email: info@portlandvetmi.com

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Hours

Monday, Tuesday, Wednesday & Friday:
8 AM-5 PM
Thursday: 8AM – 5PM
Saturday & Sunday: Closed

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Email *

Phone

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