*Your Name:

*Main Phone:

Alternate Phone:

If you would like to receive a post-op text message about your cat, please provide your cell phone number (if different than above):

*E-mail Address:

*Time of cat’s last meal:

If your cat is diabetic, provide the date/time when last insulin injection was given:

Is your cat on any medication? Name of medication:

Date/time when medication was last given:

I consent and authorize Cat Hospital of Chicago to perform the following tests:

I understand that if my cat is not current on his/her rabies and distemper/upper respiratory virus vaccines (core vaccines recommended for all cats, whether indoor or outdoor), and assuming my cat is healthy enough, as determined by the veterinarian performing the procedure/operation, to respond to the vaccines, the vaccines will be given and the fee added to the invoice. I understand that this is for the protection of my own cat, as well as the other hospitalized cats and hospital staff. Should I opt to decline having the recommended vaccines updated on my cat, I understand and agree that my cat(s) will be housed in the isolation area of the hospital, to protect them as well as other hospitalized patients, and that there will be an isolation ward surgical boarding fee charged.

Procedures requiring anesthesia always carry a degree of risk, whether the patient is a person or a cat, including the fact that the use of anesthesia as part of the procedure may cause injury or death to my cat. The likelihood of anesthetic complications is extremely low, and in most cases, anesthetic complications are not life threatening.  However, like you, we want to minimize that risk as much as possible. This requires a pre-operative physical examination (even if your cat has been examined by one of our veterinarians recently) and pre-anesthetic tests. General anesthesia has become very safe in recent years with the advent of newer drugs and more sophisticated patient monitoring. Some conditions may not however, be evident on a physical examination. To better ensure your cat’s safety during anesthesia, we require that pre-anesthetic blood tests be performed pre-operatively on all patients if not recently done. For most surgical procedures an intravenous catheter is placed so that intra-op fluids can be administered. This necessitates shaving a small patch of fur. In most cases the fur will grow back within the next several weeks.  If not already done, we also advise that feline leukemia and feline immunodeficiency virus testing be performed on all patients. Occasionally the doctor may also recommend pre-operative chest and/or abdominal x-rays on your cat. If x-rays are necessary and have not been previously discussed with you, the veterinarian will contact you directly prior to this being done.

I authorize Cat Hospital of Chicago to perform recommended/required pre-operative in-house lab tests as determined by the attending veterinarian.

Microchipping your cat will enable identification if he/she is ever lost. A data chip approximately the size of a rice grain is inserted under the skin between the shoulder blades and can be scanned for owner and veterinarian information. Would you like us to microchip your cat while under sedation?

Yes No

Regarding a dollar estimate for today’s test(s)/procedure(s)/operation(s), check one of the following:

I do not require an estimate for today’s test(s)/procedure(s)/operation(s).

I have spoken with/received a message from a hospital technician or veterinarian and have received a dollar estimate for today’s test(s)/procedure(s)/operation(s).

Our cats do not show pain as we do. They do not complain as we do and they accept levels of pain that we could not imagine. It has been shown that humans recover better and faster if they are pain free. It is the same for our cats. We will automatically administer prophylactic (preventative) pre and post-operative pain injections and pain medications will be sent home for any procedures deemed to be associated with any degree of pain for your cat. In some cases, a pain patch (which slowly releases pain medication) will be placed on your cat for 72-120 hours of post-op pain relief. Because it may affect the type of pain medication (if necessary) that is sent home with your cat, please notify one of our staff members if there are children in the home.

If needed, I prefer to get my take-home medications in:

I understand the procedures to be performed and the risks involved. I authorize the veterinarians and staff to perform any life-saving procedures deemed necessary in the event of an emergency.

I understand that my cat will be considered abandoned if Cat Hospital of Chicago has not heard from me within 7 days of the expected date of discharge. Cat Hospital of Chicago is authorized to dispose of my cat as they deem best, and I am still financially responsible for all charges accrued.

I certify that I understand this consent form, and furthermore assume full financial responsibility of all charges.

Additional Comments: