Hours & Contact
  • Mon - Fri: 8:30 AM - 6:00 PM
  • Sat: 8:30AM - 2:00PM
  • Sun: CLOSED
  • COVID-19 Hospital Protocols
  • Emergency Information
  • Download Our App
  • Pay now with CareCredit
  • 880 Muddy Branch Road
    Gaithersburg MD, 20878
  • (301) 963-0275
  • [email protected]
  • facebook
  • instagram
  • youtube
  • google
Muddy Branch Veterinary Clinic
Main Menu
Menu
  • Services
    • Cat Services
    • Dog Services
    • General Services
      • Acupuncture
      • Dentistry
      • Diagnostics
      • Emergency Care
      • Nutrition
      • Orthopedic Surgeries
      • Preventative Care
    • Rehabilitation & Underwater Treadmill
  • About Us
    • Our Team
      • Doctors and Management
      • Veterinary Support Team
      • Client Service Representatives
    • Policies
    • Hospital Tour
  • Resources
    • Forms
    • Blog
    • Helpful Links
    • In Memoriam
    • Purina Vet Direct
  • New Clients
  • Pharmacy
    • Online Pharmacy
    • Pickup at Hospital
    • Purina Diets
  • Join Our Team
Fear Free

Treatment/ Surgical Consent Form

What procedure, surgery or treatment are we performing on your pet today?
Please type the procedure in "other" field.

If your pet is scheduled for a sedated surgery or procedure - Please do not feed your pet after 10pm the night before, water is allowed.

Does your pet have a history of seizures?
Enter surgery or treatment
We offer the 911 Pet Chip! This chip has a one time implantation and registration fee. Would you like your pet to be microchipped with 911 Pet Chip?
Estimates: The estimate, which you may have been given, is based upon the entering examination of your pet and may change as further diagnostic and therapeutic procedures dictate. The estimate is just that, charges may change. Final charges will be based on the actual services provided. If we must exceed this estimate, we will work hard to contact you. Would you like the doctor to call you to discuss the estimate prior to starting the procedure?
Dental Procedures: If your pet needs teeth extracted we will make every effort to contact you two times for consent. If we cannot reach you and you would like us to move forward with extraction of diseased teeth do you consent to us doing this knowing there are additional fees that can range from $200-$700 depending on the difficulty of extraction.
I intend on using Carecredit as my payment method for my invoice total. I acknowledge full payment is due at the time of service. With invoices of $200 and greater, we offer 6 months of deferred interest on Carecredit transactions. Discounts will not be applied for Carecredit Transactions.
Are you a Trupanion Policyholder? If yes, would you like us to submit your claim for today's invoice?

Acceptance & Authorization

I understand and accept that the estimate may change. I understand that the treatment/surgery provided will be conducted with due care and in accordance with the prevailing standards of competency in Veterinary Medicine and that no guarantee of assurance has been made as to the results that may be obtained through the course of treatment undertaken by Muddy Branch Veterinary Center, its Veterinarians, agents or employees. I also agree and understand that all anesthesia and surgery involves a certain amount of risk to my pet.

I agree to be responsible for all charges relating to my pet's medical care. If any unforseen medical or surgical needs arise, I hereby consent to any medications and supplies purchased or prescribed and understand that additional costs will be my responsibility. I understand a deposit may be required for hospitalized animals. I agree to pay the balance of all charges in full at time of discharge. I also understand that the hospital is not staffed 24 hours a day. I understand that MBVC requires preanesthetic lab work along with pre and post pain medication for my pet if needed.

I understand that Muddy Branch Veterinary Center does not offer after hours pick ups. A fee of $1 per minute late will be applied for late pick up from surgery or drop off procedures.

At Muddy Branch Veterinary Center, we care about your pet's safety and comfort. We require lab work, IV catheters, and IV fluids on all surgical cases, and pain relief to assist in post-surgical pain management.

Kennel cough is a upper respiratory condition caused by a variety of viruses and bacteria often spread by direct contact by dogs. At Muddy Branch Veterinary Center, we HIGHLY recommend (but do not require) that your dog be immunized & kept up to date with their Bordetella (Kennel Cough) vaccine. Keeping your dog current with their immunization will help to prevent the spread of kennel cough and/or diminish the severity of infection in your pet. With the recommendation that all dogs visiting us be vaccinated against kennel cough, if a pet should become infected, all treatment and costs associated shall be the pet owner’s responsibility.

Sign above
CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Share this content

  • twitter
  • email
  • pinterest
  • facebook

Review Us!

Muddy Branch Veterinary Center   review us!

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

  • facebook
  • instagram
  • youtube
  • google
Get In Touch
  • 880 Muddy Branch Road
    Gaithersburg MD, 20878
  • (301) 963-0275
  • [email protected]
Muddy Branch Veterinary Center
decor image on Muddy Branch Veterinary Clinic
  • About Us
  • Services
  • Testimonials
  • Contact Us
  • Privacy
  • Accessibility
  • Login / Account

©2025 Muddy Branch Veterinary Center. Resource Articles ©2025 GeniusVets. All Rights Reserved. Veterinary websites by GeniusVets