Please Note: We will be closed on Tuesday, December 24th and Wednesday, December 25th for Christmas. Additionally, we will be closing early at 3 PM on Tuesday, December 31st and will be fully closed on Wednesday, January 1st in observance of New Years!

Treatment Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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Callaway County Small Animal Veterinary Clinic

This lets us record our pets and owners into our management software so that we can effectively and efficiently provide the service you deserve!

Client's Name *

First

Last

Patient's Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Species *

Sex *

Male
Female
Spayed Female
Neutered Male

Phone *

Color *

Referral Hospital

Birth Date

Contact number where you can be reached today *

I, as the owner or party responsible for the above pet hereby authorize the doctors and staff of Callaway County Small Animal Veterinary Clinic to perform the following procedure(s): *

On the

Left
Right
Both
Non-applicable

Choose one

I understand that anesthesia may need to be administered as part of any diagnostics and/or surgical procedures. It has been explained to me that conditions may arise during this procedure whereby a different or additional procedure may need to be performed. I understand that all efforts will be made to contact me prior to such procedures being performed, but there may be instances where it is in the best interest of my pet to proceed without delay.

Signature *

Clear Signature

Treatment Consent Form

Callaway County Small Animal Veterinary Clinic

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