Online Forms
Surgery Admittance Release Form
Thank you for choosing St. Louis Veterinary Center, we greatly appreciate it. Please fill out the form as accurately as possible.
Get Started

Surgery Admittance Release Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 314-773-6400 for a faster response.

Pet Owner:

Please review the following information and update any changes necessary.


Flea Control:

In order to control the spread of fleas and diseases they may carry, every pet seen with live fleas will be given a $8.50 (per pet) flea pill at the pet owner’s expense. This is for the protection of all our patients, clients, and staff.

Enter initials to acknowledge above statement.

Surgical Procedure(s):

(Spay/Neuter, Declaw, Dentistry, etc.)

In order to offer the best care for your pet, we will attempt to provide, to the best of our ability, either a written or verbal (via phone call) estimate of fees for your pet’s treatment plan prior to performing any testing or treatment. However, in the event that we are unable to contact you, do you have a budget that you can pre-authorize so we can proceed with the doctor’s recommendations for your pet(s):

Enter initials to acknowledge above statement.

Authorization for Anesthesia/Surgery

I verify that I am the legal owner or authorized agent of the above pet. I authorize the above procedures to be performed on my pet by the staff of St. Louis Veterinary Center. St. Louis Veterinary Center is to use all reasonable precaution against injury, escape, or death of my pet. I understand that anesthesia and surgery always involves some risk to my pet and agree to hold you harmless, in the absence of negligence, in connection with these procedures.

I further acknowledge that no guarantee or assurance has been made to me as to the results that may be obtained. Additionally, this clinic and any associated organization are not responsible for any complications resulting from pre-existing conditions, or improper care of my animal(s) that may have occurred prior to the procedure. In the event complications arise and I cannot be immediately contacted at the above contact information, I authorize St. Louis Veterinary Center staff to provide emergency care based upon the veterinarian’s professional judgement of what they deem best for my pet and understand that any additional costs associated are my responsibility.

I hereby certify that I have read and fully understand the above authorization.