Surgical Consent Form

OWNER INFORMATION

PATIENT INFORMATION


OWNER ACKNOWLEDGEMENT & AUTHORIZATION


i.e. Hernia Repair, Dewclaw Removal, Deciduous Teeth, etc.

 

I understand that if my pet arrives at the clinic and evidence of fleas is noted by the veterinarian upon examination, treatment with a flea medication (Capstar) at a cost of approximately $9-$11 is required to proceed with surgery and/or hospitalization. This is to avoid contamination of the hospital environment, maintain sterile conditions during surgery, and protect other patients from infestation. *
 
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Risks of Sedation/ General Anesthesia:
These include but are not limited to: hypotension (low blood pressure), kidney injury, tracheal injury, hemorrhage (blood loss), drug reactions, aspiration pneumonia, hypothermia (low temperature), cardiopulmonary arrest, and death. All patients are monitored during anesthesia events by licensed technicians, and fluids can be provided intraoperatively to minimize risks of hypotension and low tissue perfusion as necessary. Active warming helps to reduce risk of hypothermia, and pre-anesthetic blood work decreases risk of complications from underlying disease, especially in older animals. Fasting prior to surgery minimizes the risk of inhaling regurgitated material (and therefore, aspiration pneumonia). Additional risks depend on the nature of the procedure, e.g., post-operative incision breakdown, infection, seromas (fluid pockets), bruising, and hematomas (blood pockets under the skin). In older animals or those with pre-existing conditions, additional testing may be recommended prior to anesthesia to minimize risk.

 

Consent for CPR or DNR:
In the case that your pet was to suffer cardiac and/or pulmonary arrest (heart or breathing stops), do you authorize us to provide Life-saving measures (i.e. cardiopulmonary resuscitation)? Costs of these services can be $500+ and are NOT reflected in the surgery estimate, and may not always be successful. If you choose to allow these procedures for your pet, you will be contacted as soon as possible to be informed of the situation.

Do you authorize us to provide life-saving measures? *

Intravenous Fluids:
IV fluids are important during anesthesia, including improving tissue perfusion and managing blood pressure. Fluids are provided during surgeries (minus feline neuters) at no additional cost.  Your pet will remain on IV fluids post-surgery for recovery, at the veterinarian’s discretion.

 

Pre-Anesthetic Testing is offered to all surgery patients at a cost of $180.00 plus tax. It will be mandatory for certain surgeries, at the veterinarian’s discretion. This blood test is done to detect underlying organ dysfunction which may not be evident during a physical examination and thus to minimize the risks. A 40% discount will be applied for patients that are enrolled in the Healthy Start program. Not Optional for patients enrolled in the Healthy Start Program.

 
 

Microchipping is offered at a cost of $85.60 plus tax. Microchips are about the size of a grain of rice and are inserted under the loose skin between the shoulder blades. When scanned, this can show a unique ID number to help lost pets find their owners. Microchips must be registered with the microchip company to associate your name and contact number with the microchip ID number. Not Optional for patients enrolled in the Healthy Start Program.

 

Deciduous Teeth Extractions are offered at a cost of $26/tooth + tax and $125 + tax for dental x-rays (for spays/neuters). Dental x-rays allow us to detect any potential dental issues that may not be visible during a routine exam, such as tooth abnormalities, missing teeth or retained deciduous (baby) teeth. Extraction of deciduous teeth is important to prevent potential dental issues. Retained baby teeth can cause misalignment, pain, infection, and interfere with the proper eruption of adult teeth. A 40% discount will be applied for patients that are enrolled in the Healthy Start program.
 

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