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Owner*

Pet's Name*

PLEASE PROVIDE A PHONE NUMBER WHERE YOU CAN BE REACHED AT ALL TIMES ON DAY OF APPOINTMENT. This is extremely important; the Doctor must be able to reach you if there is a question during the procedure.

Phone Number*

MICROCHIP to return lost pets: A microchip is now available to return your pet to you quickly and safely in the event they run away. It’s the size of a grain of rice and is inserted under the skin. It causes no discomfort and remains active for the life of your pet. If your pet accidentally gets away and is taken to a shelter or animal hospital, a scanner will pick up the microchip’s number for your pet and you will be called immediately.

The cost is $65.25 for the chip, this includes lifetime registration.*

YES, I would like a microchip for my pet – Great Choice!

NO, I would not like a microchip for my pet

My pet is microchipped – Fantastic! Make sure you have updated your contact information.

ESTIMATE: I have received an estimate of the cost for the following procedure*

YES

If not, I want an estimate before the procedure is done.

YES

I hereby authorize performance of the following surgical or other procedure(s):

Procedure name*

Date of Procedure

Other

I understand that during the performance of the foregoing procedure(s) or operations(s), unforeseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) or operation(s) in addition to those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operations(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgement.

I also authorize the use of appropriate anesthetics and other medications, and I understand that the hospital support personnel will be employed as deemed necessary by the veterinarian.

The nature of such service has been described to me to my satisfaction and I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure.

Surgery Consent #1*

I understand I assume financial responsibility for all services rendered, and that payment is due on the date of procedure.

Surgery Consent #1*

I understand that there is a 48 hour cancellation policy and that I will be assessed a $300 missed appointment fee if I do not cancel or reschedule my pet’s procedure with at least 24 hours’ notice. I assume financial responsibility for the charge in this event.

Signature*

Date*

BLOODWORK CONSENT FORM

Our greatest concern is the well-being of your pet, especially during anesthesia. Our well-trained staff use state-of-the-art monitoring equipment and the safest anesthetic available. These precautions help to make our anesthesia very safe for the healthy pet. Prior to anesthesia, our staff will obtain a complete history of your pet, and the veterinarian will perform a complete physical examination. This provides us with vital information about your pet’s health. However, it is impossible to understand the complete physiological picture without performing blood tests. The blood tests we recommend are like, and equally as important, as those your own physician would run if you were to go under anesthesia.

It is important to understand performing these tests does not guarantee complications will not occur. They are important in minimizing the risk of anesthesia, and they provide you and us with peace of mind. They may also identify a medical condition that is not apparent by physical examination alone.

In some cases, abnormal blood tests will cause us to delay a surgical procedure and attempt to diagnose the medical problem causing the abnormal tests. In many instances, these values will help us determine which pre-medication agents to use for your pet’s safety and the need for additional medications after surgery. We can alter standard protocols based on your pet’s particular values. If tests are normal, we can proceed with a greater degree of confidence, and we will have established an excellent set of baseline values to use and compare should your pet become ill in the future.

If your pet has NOT had pre-operative bloodwork already, we strongly recommend one of the following panels be done. PLEASE CALL US WITH QUESTIONS REGARDING BLOODWORK

Please select one*

A. Total Body Function (recommended for all ages; REQUIRED for animals ages 8+ or with preexisting conditions) ($301.00): Most complete bloodwork panel, giving full chemistry values, red & white blood count (CBC), thyroid, electrolytes & more. MUST BE SCHEDULED 48+ HRS PRIOR TO PROCEDURE

B. Pre-Op Lab Screening w/ Clotting (appropriate for animals up to age 7, with no pre-existing conditions) ($142.00): All the information from the Complete Chemistry Panel below plus CBC & clotting values. MUST BE SCHEDULED 48+ HRS PRIOR TO PROCEDURE

C. Bloodwork Completed

D. DECLINE: I decline recommended pre-anesthetic blood tests and request you proceed with anesthesia. I understand a medical condition may exist that would be impossible to identify during a physical examination alone. I understand my pet’s health could be at risk if such a condition goes undetected when my pet is placed under anesthesia.

Date bloodwork was completed*

PLEASE NOTE: Additional panels may be required prior to surgery, regardless of your pet’s age, based on your pet’s health history & at the doctor’s discretion.

Signature*

Date*

Emergency Contacts

Primary Contact Name*

First

Last

Phone*

Alternative Contact Name

First

Last

Phone

Emergency Care Plan

In the event that your pet requires emergency care during the stay, Best Friends Animal Hospital will make every reasonable effort to contact you at the emergency contact numbers provided. However, if you are unable to be reached prior to the time when the performance of the necessary care is deemed to be required by the attending veterinarian, the hospital staff asks your permission to provide any necessary medical care for your pet.

CPR

In the event that your pet should experience cardiac or respiratory arrest while being hospitalized, do you give consent for resuscitative efforts to be initiated until you can be contacted further and notified of your pet‘s status?

By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will continue to be performed at the doctor’s discretion.

Please select and initial your choice below

I agree to CPR being performed in case of arrest.*

Yes

I elect a “Do Not Resuscitate” status in case of arrest.*

Yes

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment.

Signature*

Date*

PRE-ANESTHETIC INSTRUCTIONS

IMPORTANT: If pre-surgery bloodwork, urine, and/or radiographs have been advised, this must be completed at least 48 hours prior to surgery.

FOOD: No food after 8:00pm the night before surgery.
WATER: No water the morning of surgery.
Please walk your dog to allow time for urination and defecation before coming to the hospital.
Please bring your pet to the hospital at 7:30 the day of surgery.
Please complete the standard consent form that was emailed to you prior to coming to the hospital.
If there is any change in the status of your pet before the scheduled surgery date, please call the office as soon as possible to alert the doctor – surgery may need to be rescheduled.

Exotic Animal Instructions: Do not withhold food. Continue regular feeding.

Comments

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Surgery Consent Form

Emergency Contacts

Emergency Care Plan

CPR

Get in touch

(847) 548-2626

Business Hours

(847) 548-2626