Consent Form

We, the Staff of Oak Grove Veterinary Hospital, value our relationship with you and your pet and hope to make any necessary procedures as easy as possible for both of you. If you have any concerns or questions before we proceed, please let a staff member know. We will do our best to provide information and an estimate in advance regarding any additional procedures to the best of our ability, but this may not always be possible. Please know that we care for your pet and would not perform any procedures we do not feel are necessary for the benefit of your pet’s health.

Thank you for trusting your pet to our care.

Authorization for Medical/Surgical Treatment
I hereby authorize Dr. Timothy Thies of OakGroveVeterinaryHospital and whomever he may designate to administer the suggested diagnostics, treatments, and/or surgical procedures. I understand that additional procedures may be medically necessary and/or recommended on the basis of findings during the course of such procedures. I also understand that the staff will do their best to contact me prior to any additional procedures, but that this may not always be possible. I have left a current contact number where I can be reached.
I consent to the administration of such sedatives and/or anesthetics as are deemed necessary by Dr. Thies. I understand that there are risks involved with the use of these drugs. I also understand that complications, though rare, can occur during any medical procedure. I authorize OakGroveVeterinaryHospital to do what is needed to care for my pet in any emergency situation that should arise while my pet is in their care.
I hereby assume financial responsibility for all charges incurred and understand that payment is due upon the hospital release of my pet. I also consent to the release of my pet’s medical information as needed to aid in his/her care.
I hereby certify that I understand the reasons for performing these diagnostics, treatments and/or surgical procedures on my pet. If I do not fully understand this need or have any reservations, I will request to speak with Dr. Thies before the procedures are set to begin. I understand that no guarantees or assurances can be made as to the results that may be obtained from these procedures.
Signature:______Contact Phone # ______
Date:______Pet’s Name:______
Please Initial:
Veterinary service during nighttime hours and/or weekends is provided at the discretion of the veterinarian in charge. Continuous presence of personnel is not provided during these hours.
Emergency Care of Critical or Unstable Patients (Additional Authorization)
I hereby authorize the staff of Oak Grove Veterinary Hospital to perform immediate diagnostics, treatment, stabilization, and/or lifesaving procedures as they deem necessary for the health of my pet. I understand that Dr. Thies will speak with me as soon as possible to inform me of my pet’s condition after assessing and initiating treatment for my pet.
I understand and authorize and initial estimate for these emergency procedures of $350- $550. I understand that additional treatment may be necessary once my pet is stable and that Dr. Thies will provide a written estimate for the charges incurred and for the predicted medical plan. I consent to this emergency estimate and agree to pay any charges incurred.
Signature: ______Contact Phone #: ______
Date:______Pet’s Name:______

Oak Grove Veterinary Hospital ♦ 512 Giuffrida Ave., San Jose, CA95123 ♦ (408) 227-1661