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Oliver Animal Hospital - SURGICAL CONSENT FORM (old)

  • 1
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  • 2
    Check all that apply to your pet
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  • 3
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  • 4
    Please enter your initials here
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    Please enter your initials here
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    Please enter your initials here
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    Please enter your initials here
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  • 8
    Please enter your initials here
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  • 9
    Please enter your initials here
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  • 10
    • Yes, I agree to the microchip placement/registration
    • No, I do not agree to the microchip placement & registration
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  • 11
    If further problems are detected while my pet is under anesthesia (check ALL that apply but do not check both the first and second boxes as they contradict one another)
    • Do whatever is needed to give my pet a healthy oral cavity including, but not limited to tooth extractions
    • Do only what I have authorized
    • Please contact me before doing any additional procedures. IF I CANNOT BE REACHED WHILE MY PET IS UNDER ANESTHESIA THEN DO ONLY WHAT I HAVE AUTHORIZED
    • My pet is not having a dental procedure today
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  • 12
    • Yes. Text Me
    • Yes. Call Me
    • No
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  • 15
    ( Enter Name & Phone # or NA )
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    Please enter your initials here
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  • 18
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