Surgery Consent Form

Complete and submit this form online — our team reviews every submission and will confirm by phone or email within one business day. All information is kept confidential.

1. Owner Details

Full name * Phone / WhatsApp * Email * Alternative phone Physical address Preferred branch Preferred contact method

2. Pet Details

Pet name * Species * Breed Age Sex Weight (kg) Microchip number Colour / markings

3. Surgery Details and Consent

Procedure / surgery name * Scheduled date * Preferred veterinarian Anesthesia type (if known) Current medications and allergies Pre-operative instructions

I understand the risks of anesthesia and surgery including bleeding, infection, adverse drug reaction and, in rare cases, death. My questions have been answered and I consent to the procedure. I authorize additional treatment if the veterinarian deems it necessary for my pet's safety.

I acknowledge the risks and give consent for the procedure and anesthesia. * I consent to additional procedures if deemed necessary. I understand post-operative care instructions will be provided and I will follow them. *

Estimated cost acknowledged (KES) Payment method

Signature *

Sign with your finger or mouse. By signing you confirm the information provided is true and you authorize Mobivet to proceed.

Your signature is securely stored with your submission.

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