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Hours & Contact
  • Hospital Hours:
  • Mon - Thurs: 7:30am - 7:00pm
  • Fri: 7:30am - 5:00pm
  • Sat: 7:30am - 12:00pm
  • Hospital Contact Info:
  • Phone: 262-846-6006
  • Fax: (262) 781-5278
  • [email protected]
  • Pet Resort Hours:
  • Mon - Fri: 6:30am - 6:00pm
  • Sat and Sun: By Appointment Only
  • Pet Resort Contact Info:
  • Phone: (262) 781-5277
  • [email protected]
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Brook-Falls Veterinary Hospital & Exotic Care
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Request an Appointment

Surgery Consent

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CONSENT FORM MEDICAL & SURGICAL SERVICES

Brook-Falls Veterinary Hospital & Exotic Care

Client Name

I am the owner or the agent for the owner of the animal described above, and I have the authority to execute this consent. I hereby give the doctors of Brook-Falls Veterinary Hospital & Exotic Care Inc., and any authorized agents, staff, or representatives consent to perform the following procedures or operations:

The nature of these operations or procedures has been explained to me, and I understand what will be done. I have also been informed that there are certain risks and complications associated with any operation or procedure of this type. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures. I authorize the use of appropriate anesthesia and pain relief medication as needed before or after the procedure. I have been informed that there are risks associated with the use of any medication. I understand that hospital support personnel will be used as deemed necessary by the veterinarian.

I received a treatment plan for today's procedure within the range of
  • This is an estimate only. Actual charges may vary by 15%. If the total charges exceed the estimate by more than 15%, we will consult you before administering further treatment. If you have any questions about this estimate, please discuss with your veterinarian before treatment is provided.
Name to call with update:
To receive updates today on my pet, I prefer a:

If my pet requires hospitalization after his/her procedure, I understand that veterinary care during night-time hours and/or weekends is provided at the discretion of the attending veterinarian. Continuous presence of personnel will not be provided during these hours. If further hospitalization is required, I elect to (please check one):

Election
Additional Questions
Do you wish to have your pet receive a Home Again Microchip?
Would you like to receive dental home care products?
Has your pet eaten anything at all in the last 12 hours?
Has your pet been given any medications, supplements, or treatments during the past 7 days?
Do you anticipate your pet licking at the surgical incision?
If so, would you prefer to purchase a hard plastic head cone for $ 5-14 or a soft medical pet T-shirt for $33-40?
Has your pet ever had a past anesthetic event that you thought YES NO N/A went poorly?
Do you have any questions for the Doctor this morning?
Do you need any medications refills today?

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Get In Touch
  • N48 W14850 W. Lisbon Road
    Menomonee Falls, WI 53051
  • 262-846-6006
  • [email protected]
Brook-Falls Veterinary Hospital & Exotic Care
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