Procedure Check In Form

Fill out our form for Surgery/Procedure Check In Form information below!

Surgery/Procedure Check In Form

Fill out the form below, and a member of our team will be in touch with you if we have any questions.

Anesthesia Consent

I am the owner or agent for the owner of the pet aforementioned and have the authority to execute this consent. I hereby authorize the Hoboken Vets Animal Clinic to perform the services noted above for my pet/s. I understand that some risks always exist with anesthesia and/or surgery, and I have been encouraged to discuss any concerns I may have about those risks with my veterinarian before the procedure(s) is/are initiated. Surgical and anesthetic risks include, but are not limited to, infection at the surgical site, unexpected blood loss, and anesthetic or surgical complications up to and including death.

Additionally, I hereby authorize the Hoboken Vets Animal Clinic to perform any diagnostic, treatment or surgical procedures as deemed necessary for medical or surgical complications or otherwise unforeseen circumstances. While the Hoboken Vets Animal Clinic provides the highest quality of anesthesia monitoring and surgical services, I understand that there are rare complications associated with any anesthetic or surgical procedure. I fully understand these risks and understand that the veterinarians and hospital staff will try to minimize these risks. I agree not to hold the Hoboken Vets Animal Clinic, the veterinarians or any staff member liable for any complications that may arise.

Should my pet be found to harbor any fleas, I will also assume the charges for de-fleaing my pet while in the hospital. I have read and do understand this estimate.

Should my pet be discharged from the hospital with an unpaid balance, I understand and agree to pay a finance charge of 1.5% per month on any unpaid balance. Any attorney or collection fees incurred due to delinquency in payment will be my responsibility.

No warranty or guarantee has been given to me as to the results or cure afforded by these treatments or procedures.

My signature on this consent form indicates that any questions I may have were answered to my satisfaction.

Terms and Conditions

70% of the estimate is required the day before the procedure, the remaining balance will be discussed with you post-procedure before doing the final charge out.

I, the undersigned am an authorized signer of the credit card detailed above. I authorize Hoboken Vets Animal Clinic to use the credit card information above to pay the balance due. I will be provided a copy of my receipt either by fax, mail, or e-mail at my discretion.

We schedule our appointments so that each patient receives the right amount of time to be seen by our physicians and staff. That’s why it is very important that you keep your scheduled appointment with us, and arrive on time.

As a courtesy, and to help patients remember their scheduled appointments, [Practice Name] sends text message and email reminders in advance of the appointment time. If your schedule changes and you cannot keep your appointment, please contact us so we may reschedule you, and accommodate those patients who are waiting for an appointment. As a courtesy to our office as well as to those patients who are waiting to schedule with the physician, please giveus at least 24 hours notice. If you do not cancel or reschedule your appointmentwith at least 24 hours notice, we may assess a $93 doctor and $25 technician “no-show” service charge to your account.

I understand the “no-show” policy of Hoboken Vets Animal Clinic and agree to provide a credit card number, which may be charged $93/$25 respectively for any no-show of a scheduled appointment. I understand that I must cancel or reschedule any appointment at least 24 hours in advance in order to avoid a potential no show charge to the credit card provided.