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TVSS Elective Surgery Consent Form

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We look forward to seeing you soon. Please complete this form before your visit, and we’ll be ready for you and your furry family member when you arrive!

Owner's Name *

First

Last

Pet's Name *

Surgical Procedure (if applicable, MUST include which limb) *

Email *

My Phone Number Today *

Do you give TVSS permission to use your pet’s picture/video & first name on TVSS social media sites? *

I have been advised as to the nature of the surgery described above and the risks involved. I authorize, Jefferson Nunley DVM, to perform this surgery. I also understand that Family Pet Health (with the assistance of the TVSS team as needed) will be using appropriate anesthetics (including epidurals & CRI’s per Dr. Nunley) and medications needed to perform this surgical procedure and will be responsible for monitoring my pet. *

I have read and understand

Signature *

Date *

***If this form is not complete, the surgery will have to be rescheduled***

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