Surgical/Anesthetic Consent Form

Client’s Name

Email Address

Pet’s Name

^{** Please initial procedure/treatment listed above**}

PRE-ANESTHETIC LAB WORK: Your pet will be undergoing major surgery under general anesthesia today. In order to recognize any underlying abnormalities your pet may have, which may put them at a greater anesthetic risk, we recommend a pre-anesthetic blood profile to be run on your pet. This consists of a CBC, which will check blood cells, and a small chemistry panel, which will check blood glucose, protein, and kidney/liver function. These blood tests will help us to assess the health status of your pet more completely and determine if there are any additional precautions we need to take before surgery.

Yes

lab work ($162)(Required for animals over 6 years old)

POST-SURGICAL LASER TREATMENT: The therapeutic laser can be used around the incision site to help relieve pain, reduce inflammation and scar tissue, and accelerate tissue healing. (Not forgrowth removals, around eyes or staples)

Yes

do a laser treatment on my pet ($16)

E-COLLAR “CONE”: Helps prevent any chewing or licking at surgical site. (If during recovery, the patient starts licking at the site, an e-collar will be automatically placed on pet.)

Yes

send my pet home with an e-collar ($13-$25)

MICROCHIP: While under anesthesia, we can safely insert a microchip under your pet’s skin, between their shoulder blades, which offers permanent identification and helps assist in your pet’s safe return in the event that he/she is lost or stolen.

Yes

insert a microchip ($65)

OTHER(toe nail trim, express anal glands, etc.)

Please list any medicines (over the counter or prescribed) your pet has received within the last two weeks:

Phone number(s) where you may be reached during the day (please list all):

I understand that some risks always exist with anesthesia and/or surgery and that complications and even death are possible. I understand that I am encouraged to discuss any concerns I have about these risks with the attending doctor before the procedure(s) is/are initiated. I also understand that the veterinarian will perform a pre-anesthetic physical exam and that the staff will be monitoring my pet at all times while under anesthesia in order to minimize anesthetic risk. I realize that no guarantee can be made legally or ethically to me regarding the outcome of any procedure performed. I am the owner or responsible party of the above described animal and have the authority to execute this consent and authorization. I have carefully read and do fully understand this authorization and consent.

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Surgical/Anesthetic Consent Form

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