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Rescue Forms

Rescue Forms

Rescue Forms

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WEIR VETERINARY SERVICES

RESCUE SURGICAL & ANESTHETIC CONSENT FORM

Rescue Name:
Pet’s Name:
Date of Surgery:
Owners Name:
Breed:
Sex:
Age:
Weight:
Color:
Please check (√) all that apply:
is due for vaccinations, to be administered today
first vaccine (ie; vaccinations will require booster(in 4 weeks))
is/may be pregnant; please proceed with spay at additional costs
has been fasted for 12 hours prior to admittance
microchip
additional request for services as listed below:

I hereby authorize the veterinarians and staff of Weir Veterinary Services to use anesthetics and medications.

The Rescue Agency agrees to pay, in full, for all checked off services as listed above.

Please list services NOT to be billed to the Rescue Agency, but to be billed to:

The possibilities, outcomes and risks have been explained to me.

I have read and understood this authorization and consent.

E-Signature / Name of Rescue Agent (please print): *
Date: *
Phone number(s) where Agent (s) can be reached today:
Pet to be picked up upon discharge today by:

INFORMATION

Weir Veterinary Services
5603 44 Street
Lloydminster Alberta T9V 0B2
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HOURS OF OPERATION

Monday ............... 8:00am - 5:30pm
Tuesday ................ 8:00am - 5:30pm
Wednesday ........... 8:00am - 5:30pm
Thursday ............. 8:00am - 8:00pm
Friday ................... 8:00am - 5:30pm
Saturday ................ 9:00am - 12:00pm
Sunday .................. Closed

QUICK CONTACT FORM

PLEASE NOTE Our email is not monitored outside of regular business hours.
If you have an emergency, please call
780-875-2281.

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