General Surgical Consent Form

Provide consent for your pet’s surgical procedure at Victoria Veterinary Clinic. Please complete this form prior to your pet’s surgery and ensure all medical history and concerns are recorded.

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A Weimaraner dog with its mouth open and tongue visible,

About Our Surgical Procedures

Our surgical services cover a variety of routine and specialized operations. All patients under anesthesia receive intravenous fluids to help maintain blood pressure, improve circulation, and support a smoother recovery. Post-surgery, a 24-hour injectable pain medication will be given, and your pet will be sent home with a 3-day course of oral anti-inflammatory medication. Optional surgical enhancements, such as laser incisions or microchipping, can be performed at the same time.

Complete the Form

Consent Form for Surgical Procedures

Date of Surgery(Required)

MM slash DD slash YYYY

Patient Name(Required)

Client Name(Required)

First Last

Email(Required)

Is your pet fasted?(Required)

Yes

Is your pet on any medications?(Required)

Yes

Medication Name

If your pet is taking multiple medications, list them all here.

Medication Dose

If your pet is taking multiple medications, list the dose for each medication.

Medication Last Given

If your pet is taking multiple medications, list the date each medication was last given.

Any signs of illness?(Required)

Yes

If yes, would you like an exam done? Cost: $104.50(Required)

Yes

Concerns(Required)

Surgery to be Performed (Check all that apply)(Required)

Canine Spay under 40 lbs — $494.74

Canine Spay over 40 lbs — $576.49

Canine Spay over 80 lbs at — $636.60

Canine Neuter under 40 lbs — $453.74

Canine Neuter over 40 lbs — $535.49

Feline Spay — $389.04

Feline Neuter — $202.04

Cryptorchid

Hernia

Retained Teeth

Growth Removal

Canine Dewclaw Removal

Would you like the growth sent for analysis?(Required)

Yes (additional fees apply)

Location of lump(s):

Other procedure(s):

Intravenous fluids will be administered during anesthesia to help maintain blood pressure, increase circulation and help your pet recover more quickly. A 24-hour injectable pain medication is given post-operatively. Your pet will also be sent home with three days of an oral anti-inflammatory medication to be given at home to reduce pain and inflammation.

Surgical Options (Check Accept or Decline)

For Spay Surgery: If pet is found to be pregnant, proceed with spay - Cost: $58.00–$109.00(Required)

Decline

Presurgical blood test for pets under 7 years - Cost: $89.50(Required)

Decline

Checks for proper organ functions, oxygen carrying ability of blood, ability to fight infection, platelets for proper clotting and to establish a baseline for future reference.

Presurgical blood test for pets 7 years and older - Cost: $131.50(Required)

Decline

Same as the presurgical blood test above but includes more extensive testing.

Microchip - Cost: $49.00(Required)

Decline

A small chip used for identification throughout North America. It is implanted beneath the skin between your pet’s shoulder blades.

Elizabethan Collar - Cost: $9.60-48.49(Required)

Decline

Prevents licking or chewing of the incision area.

Medical Shirt - Cost: $40.06-46.95(Required)

Decline

Prevents licking or chewing of the incision area. Shirt is not used for cat neuters.

Pedicure - Cost: No Charge(Required)

Decline

Nails are clipped while your pet is anesthetized.

Vaccinations - Core vaccines: $104.50-134.50(Required)

I authorize vaccines

My pet is vaccinated

I decline vaccines at this time

Our clinic recommends all pets have up to date vaccines. This helps prevent the spread of infectious diseases.

I authorize the veterinarians and staff at Victoria Veterinary Clinic to perform cardiopulmonary resuscitation (CPR) (including chest compressions, intubation, and emergency medications) in the event of a respiratory or cardiac arrest.(Fees apply)(Required)

Decline

I authorize and direct the Veterinarians of the Victoria Veterinary Clinic to perform the services indicated above and/or do any other therapeutic procedures that in their judgment may dictate to be advisable for my pet’s well-being. The risks and nature of the procedures have been explained to me, and no warranty or guarantee has been made as to the result or cure.(Required)

I hereby authorize and direct the Victoria Veterinary Clinic to provide such additional services for my pet as they deem reasonable and necessary, including, but not limited to the administration of anesthesia and the performance of services involving pathology and radiology, and I hereby consent thereto.(Required)

Fees must be paid before my pet leaves the clinic.(Required)

Contact Information

I may be reached at the following number(s)(Required)

Would you like a text message photo update of your pet?

Yes

Number(Required)

Name(Required)

Signature(Required)

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Request an Appointment Today

Victoria Veterinary Clinic offers full-service veterinary care for dogs and cats in Regina, SK, as well as nearby areas like White City, Pilot Butte, Lumsden, Emerald Park, and East Regina. As a Fear Free Certified clinic, we focus on reducing stress while providing expert care in wellness, surgery, diagnostics, dentistry, and cat boarding. Ready to get started? Request an appointment below.

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Have a Question?

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Location

Victoria Veterinary Clinic
628 Victoria Ave
Regina, Saskatchewan S4N 0R1

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Contact

Phone: (306) 522-8802
Email: vvetclinic@gmail.com

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Hours

Monday – Thursday: 7:30 AM – 7:00 PM
Friday: 7:30 AM – 6:00 PM
Saturday: 9:00 AM – 4:00 PM
Sunday: Closed
Statutory Holidays: Closed

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email(Required)

Phone

How can we help you?(Required)