Lumpectomy form - Burrard Animal Hospital + Emergency

Thank you for choosing our hospital! Please feel free to contact us if you have any questions regarding any of our services.

IMPORTANT: Service dates and arrangements are not confirmed until you have received notification. A staff member will contact you by phone or email.

AUTHORIZATION

I Am Authorizing The Following Procedures: Blood Work, IV Fluids, General Anesthesia, Lumpectomy, Antibiotic Injection, Analgesic Injection, Nail Trim, Possible Medication To Go Home. *

Accept
Decline

*If you choose to decline, please do not complete this form and call our hospital.

Full Name *

Email Address *

Phone *

Pet's Name *

Has your pet been here before? *

Yes
No

Please fill out any Comments or Special Instructions below (i.e. request for additional veterinary services, etc.)

Drop off Date *

Drop off Time - Must Be Between 7a.m. - 9a.m. *

I can be contacted at anytime during the day of the procedure at this number *

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

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Authorization Form - Lumpectomy

AUTHORIZATION

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