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.

 

Pre-Anesthetic Testing:

 

To detect underlying organ dysfunction which may not be evident during a physical examination and thus to minimize the risks, the following diagnostic tests are recommended prior to anesthesia:

 
  • Total plasma protein (dehydration)
  • Blood urea (kidney function)
  • ALT (liver function)
  • Creatinine (kidney function)
  • Glucose (diabetes)
  • ALP (liver function)
  • Complete Blood Count (infection, anemia)
 

Pre-Anesthetic Testing is offered to all surgery patients at a cost of $180.00 plus tax. 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.

 
 

Anesthesia Support (IV Catheter):
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.

   
 

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? *
 

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 will be registered with the microchip company to associate your name and contact number with the microchip ID on your behalf. Not Optional for patients enrolled in the Healthy Start Program.

 

For your microchip, please provide an alternative contact in case you're unreachable:

 

Privacy Preference:

If your pet is found, would you prefer 24Pet to contact you, or do you allow your information to be released to the finder? *
Security Question *