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Laser Surgery Consent Form

* Marks requires fields.

After clicking "Submit" you will be able to print and/or save the form for your future reference. You can save it by going to "File → Save As" menu option of your browser.

Owner's Name: *
Address: *
City: *
State: *
Zip Code: *
Home Phone: *

Pet's Name: *
Date of Birth: *
Sex: *	Male: Female:
Breed: *
Description: *


Your pet is coming in for:

We are pleased to introduce laser capability to our surgical procedures. There are many benefits of laser technology: Reduction of post-operative pain as it seals and soothes nerve endings. Minimized blood loss as it seals blood vessels. Decreased swelling as it seals lymphatic vessels. Increased precision in surgery. Minimized sutures. Decreased infection as a special tissue membrane is applied to the wound for protection.
Laser surgery is offered at Savannah Animal Hospital as an enhancement to our surgical procedures. Please choose one of the following options:

Yes, I want my pet to have laser surgery for an additional fee of $98.00 No, I don't want my pet to have laser surgery I wish for the doctor to use his/her discretion

Telephone number (where you can be contacted)

Date: