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True Companion

9818 Fry Rd Ste 180. Cypress, TX 77433

832-930-7717

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    • Medical Concern Form
    • Annual Exam Form
    • Tech Appointment Form
    • Medical Progress Exam Form
    • Anesthesia/Surgical Consent Form
  • Join Our Team
  • Contact Us
  • Home
  • COVID-19
  • About Us
  • Services
    • Schedule Appointment
  • Emergency Care
  • Refer a Friend
  • Testimonials
  • Forms
    • Scheduling / New Client Registration Fee
    • Hospitalization Form
    • Medical Boarding Form
    • New patient/New client Form
    • Emergency Exam Form
    • Medical Concern Form
    • Annual Exam Form
    • Tech Appointment Form
    • Medical Progress Exam Form
    • Anesthesia/Surgical Consent Form
  • Join Our Team
  • Contact Us

Anesthesia/Surgical Consent Form

Please fill out this form as completely and accurately as possible. All anesthesia/surgical procedures need to be dropped off between 7:00 AM and 8:00 AM the day of the procedure. Make sure your pet does not eat anything past midnight the night before the procedure.

Name(Required)
Sex
I, the undersigned owner or agent of the pet identified above, authorize the staff of True Companion Veterinary Care to perform the above procedure(s).(Required)
All anesthesia/surgical procedures need to be dropped off between 7:00 AM and 8:00 AM the day of the procedure. Make sure your pet does not eat anything past midnight the night before the procedure.(Required)
Microchip:
There is an additional fee for this
Nail Trim:
There is an additional fee for this
Do you need heartworm or flea prevention:
There is an additional fee for this
Does your pet have a history of seizures?(Required)
Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure?
Does your pet need vaccines, heartworm test, anal gland expression or fecal test?
*There is an additional fee for this*
Have you given your pets any medications or supplements in the past week?
Is your pet on any medications consistently?(Required)
After procedure:(Required)
Would you like us to text you after the procedure, or would you prefer a call?
Social Media/Photo Permission(Required)
Do we have your permission to post photos of your pet online? Your pets' picture or video may be taken while they are with us and used for True Companion Veterinary Care advertisement (www.truecompanionvetcare.com) or other social media purposes (Facebook, SnapChat, Instagram, Twitter, Tiktok, etc.). Please indicate if you authorize for their pictures/videos to be posted or used. * If you do not authorize for your pet’s picture to be included in our marketing materials/venues, we may still use a picture of your pet in our patient records for our internal identification only*
Procedure Risks(Required)
I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian or technician before the procedure(s) is/are initiated. I acknowledge and understand that the above stated procedure(s) bear(s) certain known and unknown risks or unanticipated risks, which could result in injury to my pet, including, the possibility of its death. I also understand and realize that additional risks of the procedure(s) may include adverse reactions to my pet, such as, but not limited to, allergic reactions from medications and/or complications or death during (or after) surgery.
Post - Procedure Risks(Required)
While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.
Financial Responsibility(Required)
I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above.
I am at least 18 years of age(Required)
I verify I am at least 18 years of age and I am the owner or authorized agent of the above pet.
Emergency Medical Attention(Required)
If your pet needs emergency medical attention or becomes ill, our staff will make every effort to contact you. However, if we cannot contact you, we will proceed with minimal acceptable medical care until you can be reached. You will be responsible for any incurred expenses.
Hospitalization Authorization(Required)
I hereby consent and authorize True Companion Veterinary Care to receive and hospitalize my pet. I understand the hospital will use all reasonable precautions for the safekeeping of the described pet, but the hospital will not be held responsible in any manner whatsoever on account of medical situations that may arise, as it is thoroughly understood that I assume all risks. I also understand that hospital personnel are not present continuously after normal business hours. I have read, understand and agree to all provisions of this agreement.
CPR PERMISSION(Required)
I understand True Companion Veterinary Care, PLLC (TCVC) requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of TCVC, PLLC will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400. I understand that there is no guarantee of successful resuscitation. 
Cancelation Policy(Required)
PHOTO ID REQUIRED FOR PAYMENTS(Required)
Photo ID required for all credit card, debit card, care Credit and Scratchpay transactions. The photo ID must match the name on the card. All Care Credit holders must be present and sign the transaction in person.
TERMS AND CONDITIONS(Required)
While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions. I have been provided an estimated cost for the procedure(s) listed above. I assume financial responsibility for the recommended services and will provide payment in full at the time my pet is discharged from the hospital. I have read and fully understand the terms and conditions set forth above.

For Dental procedures only:

Would you like a call before dental extractions?

Covid Pre-Cautions

Have you or anyone that you have had close contact with tested positive for COVID-19 in the past 14 days?
Have you or anyone in your house experienced the following symptoms in the past 14 days?
Who experienced these symptoms?

If you are ill or have been exposed to someone who is ill, we request that a family member or friend bring your pet to their appointment

Cancellation Policy(Required)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

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