New Wellness Plans

Enjoy more healthy years with your pet by enrolling in our wellness plans.

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  • Monday - Sunday: 24 Hours
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Columbia Pike Animal Hospital and Emergency Center
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Schedule an Appointment

Surgery / Anesthesia Consent Form

Name
Species
Sex
Select all that apply
As the owner, I hereby give my consent to Columbia Pike Animal Hospital and Emergency Center to perform the following. I understand that each procedure will incur separate charges.
I also authorize the following, if needed. Please refer to your estimate for charges.
Additional Needed Services: Vaccines needed may require additional exam fee. All pets admitted to Columbia Pike Animal Hospital must be current on all vaccines.
Please select one
If I am unable to be reached. I understand that I will need to reschedule an additional procedure (at additional cost) to treat any disease present.
If I am unable to be reached, Please proceed with all necessary treatments for my pet as determined by the Doctor.

I understand that during the performance of these procedures, unforeseen conditions could be revealed that necessitate an extension or variance of procedures set forth. I expect Columbia Pike Animal Hospital and Emergency Center doctors to use reasonable care and judgment in performing these procedures. The risk associated with surgery has been explained to me. I am also aware that unforeseen events resulting from the procedure will not relieve me from any obligation to pay all reasonable costs incurred regarding my pet. I understand that payment is required in full at the time services are rendered.

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Columbia Pike Animal Hospital and Emergency Center

Visit our office to get the latest in top-quality veterinary care along with unparalleled service

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  • 4205 Evergreen Ln.
    Annandale, VA 22003
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