Surgery Consent Form

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.

MICROCHIP to return lost pets: A microchip is now available to return your pet to you quickly and safely in the event he/she runs 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.

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

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.

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

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.

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.

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.

1. FOOD: No food after 8:00pm the night before surgery.
2. WATER: No water the morning of surgery.
3. Please walk your dog to allow time for urination and defecation before coming to the hospital.
4. Please bring your pet to the hospital between 7:30 and 8:00 am the day of surgery.
5. Please complete the standard consent form that was emailed to you prior to coming to the hospital.
6. 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.