Surgical Consent Form

OWNER INFORMATION

PATIENT INFORMATION


OWNER ACKNOWLEDGEMENT & AUTHORIZATION



 
 

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 $167.00 plus tax.

 
 

Anesthesia Support (IV Catheter):
We recommend that all pets that have surgery have an intravenous catheter and receive intravenous fluids during the anesthesia, surgical procedure and recovery from the anesthesia. Having a catheter placed in a vein before the induction of anesthesia allows us to treat any unforeseen complications that may arise during the procedure, i.e., hypotension (low blood pressure), cardiac arrhythmias (irregular heart rate), unusual amount of pain, etc. The administration of fluids during the anesthesia/procedure hastens the recovery process and helps maintain normal blood pressure. We will need to shave the leg for catheter placement.

 

Anesthesia Support (IV Catheter) is offered to all surgery patients at a cost of $165.00 plus tax.

 
 

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 $99.00 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.

 
 
Security Question *