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Owner's Name:

Pet's Name:

As the owner or agent of the owner of the above-named animal, I hereby give my consent to to perform an EAR CROP SURGERY on the above-named pet. By signing below I acknowledge the following: The cost of the surgery includes surgery and suture removal only. The estimated cost for the surgery is $580.00. A non-refundable deposit in the amount of $100.00 is required prior to scheduling the appointment. All aftercare is the responsibility of the owner. Cropping the ears is not a guarantee that the ears will stand. The ears standing is entirely dependent upon the owner’s aftercare. I understand that the $100.00 deposit is non-refundable and will be forfeited if not used for this specific ear crop surgery. I verify that the above-named animal has had, or will have, at least two (2) puppy vaccinations prior to the surgery. I understand that to perform this surgery anesthesia is required. Furthermore, I understand that problems can arise due to pre-existing conditions not visually evident and that results cannot be guaranteed. I agree to hold Country Vet Clinic harmless from and against any and all liability arising out of the performance of any of the procedures referred to above. Full payment is required at the time of service.

I acknowledge

Signed:

Date:

Expert Veterinary Services in Live Oak

Keeping Your Pet's Health in Check: Convenient Online Forms for Hassle-Free Care

New Patient Form

Required form for all new patients:

Additional Forms: