Surgery Form

Please fill out our Surgery Form using one of the options below if your pet is having a surgical procedure at Brogli Lane Weaver & Alexander Animal Hospital.

Book An Appointment
Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

Surgery Form

Please read the form & provide the requested information

I hereby authorize Brogli, Lane, Weaver & Alexander Animal Hospital to perform the above procedure and any associated treatment procedures deemed advisable or necessary for my pet. The nature of the procedure has been explained to me and I realize that neither a guarantee nor warranty can ethically or professionally be made regarding the results or cure.
Further, I understand that I assume financial responsibility for all services rendered and that payment is due on the date of surgery.
All animals admitted must be current on their vaccinations and must be free of external parasites. Any animal found to have fleas, ticks, or other external parasites will be treated at the owner's expense. All animals are shaved on a leg for IV catheter placement.

Medical History

Please select yes or no if you pet has

Laboratory Test Waiver

Advances in anesthesia and surgery have made routine procedures relatively safe with a low rate of complications, nevertheless, occasional problems can arise due to preexisting conditions not evident during routine pre-anesthetic examinations. Many anesthetic medications used on your pet are metabolized in the liver and eliminated through the kidneys. Any issues that could affect the function of these organs can cause serious harm to your pet and interfere with normal anesthetic recovery. To help avoid these problems, we recommend a blood profile. Results of these tests will help determine your pet's readiness for surgery. ALL surgical procedures do include risks with anesthesia. These tests will be performed (and you will be charged) unless you refuse them. IF YOUR PET IS OVER 5 YEARS OF AGE-- BLOODWORK WILL BE REQUIRED IN ORDER TO ENSURE SAFETY FOR OUR OLDER PATIENTS!
Please select yes or no to choose which bloodwork option you would like.
**ALL patients receive pain medication prior to surgical procedures**
I understand that I assume financial responsibility for ALL services rendered and/or agreed upon. Payment is due on the date of the surgery. Any medications and supplies purchased will be at an additional charge. If we are unable to reach you at the emergency contact number, we will do what is medically necessary at the owner's expense.

Caring for Pets in Murfreesboro

Brogli Lane Weaver & Alexander Animal Hospital is accepting new patients! Get in touch today to book your pet's first appointment.

Contact Us

(615) 893-1728