Surgery and Anesthesia Consent Form

dots

Authorization for Surgery and Care

Before your pet’s procedure, this form ensures you’re fully informed about what’s being done, the risks involved, and how we’ll help keep them safe and comfortable.

dots

"*" indicates required fields

Pet Owner Information

Owner:*

I am the owner or agent for the above described pet and I have the authority to execute this consent and authorization of the following procedure(s) to be performed by the admitting veterinarian, or designated associates and their assistants. The nature of these procedures has been explained to me and I understand what will be done. I have also been informed that there are certain risks and complications associated with any operation/procedure of this type. They have been explained as well.

Consent*
Owner Confirmation:*
MM slash DD slash YYYY

****Dental Procedures Only****

My pet is being sedated for a dental procedure, I authorize the hospital staff to take dental radiographs and extract teeth if medically necessary. A documented effort to contact me will be made but if unable to contact within a reasonable amount of time:
Consent
I understand if I elect to not proceed or I am unable to be contacted regarding recommended treatment it may be necessary for my pet to undergo a follow up procedure which may include further anesthesia and financial responsibility.

YOUR PET IS BEING ADMITTED FOR ANESTHESIA/SURGERY

We feel your family member deserves the highest quality care. We are committed to providing you with uncompromised veterinary service. We highly recommend a complete evaluation of your pet prior to surgical care services. If any significant abnormalities are detected we will contact you and discuss further diagnostics and/or recommendations. Below are our suggestions to enhance the safety of anesthesia, make your pet more comfortable and save you future expense. These include but are not limited to:
PRE-ANESTHETIC BLOOD TESTING ($125.00):
Our greatest concern is the well-being of your pet. We will perform a physical exam before administering anesthesia. Every pet undergoing anesthesia deserves to be screened for internal problems not readily evident on the external physical exam. These problems may include anemia, dehydration, infection, abnormal clotting and problems with the liver, kidney, heart or other organs. These conditions are not detected unless blood testing is done. Abnormalities of any of these may increase anesthetic risk. For these reasons we highly recommend a pre-anesthetic blood screening. All pets over the age of seven are required to have pre-anesthetic blood testing.
PERMANENT IDENTIFICATION ($75.00):
Very few pets find their way home without permanent identification. Ox Bottom Animal Hospital offers permanent identification for your pet in the form of a microchip. A small inert microchip with a pre-assigned number will be placed under your pet’s skin at the level of the shoulder blades. Where ever your pet may end up across the nation they can be returned home. Registration will be done by our office, and you will receive an email from PetLink. Once you receive this email, you will be able to create a username and password to have access to update all information in the future.
ECG SCREENING ($67.00):
Heart problems are the leading cause of anesthetic complications. Many heart problems are not evident by simply listening with a stethoscope. An ECG screening will allow us to be aware of any rhythm abnormalities and make the appropriate decisions for your pet from there. This is required for any animal with a heart murmur or if recommended by the doctor.
TATTOOING ($0.00):
This discreet and painless tattoo is done while your pet is still under anesthesia. This tattoo will be a small, green line on your pets’ lower abdomen that will indicate to future caregivers whether they are spayed or neutered.
Cardiopulmonary Resuscitation (CPR) or Do Not Resuscitate (DNR)
We always preform and work with the highest quality drugs and medications, but every patient has a risk of cardiopulmonary arrest (a heart attack) no matter the age and health status of your pet while under anesthesia. With this, we kindly ask you to mark below if, in the unfortunate event that your pets needs CPR, you would like us to preform this or to not take action.
ARE THERE ANY OTHER SERVICES YOU WOULD LIKE US TO PERFORM TODAY?
Signature:*
MM slash DD slash YYYY
SMS Consent
Email Consent
This field is for validation purposes and should be left unchanged.