Anesthesia / Surgical Authorization Form- Easton

Anesthetic and Surgical Procedures to be Performed
I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. Since no anesthetic or surgical procedure is trivial or routine, we assure you that your pet will receive a full physical examination prior to anesthesia, and that he/she will be monitored before, during and after the procedure. Regardless of age or health, anesthesia and surgery present a small but real risk to your pet. The doctors choose the safest anesthetic drugs, monitoring equipment and personal attention to minimize these risks as much as possible. *

I understand and agree
CPR Consent:

Should my pet require CPR (Cardiopulmonary Resuscitation), including but not limited to cardiac compressions, positive respiration, emergency medications, or other heroic interventions, I consent that the doctors at Easton Animal Hospital are given my permission to conduct such medical care.

I also understand the following:
- I agree to be financially responsible for all veterinary services provided to my pet while Easton Animal Hospital team members pursue treatment.
- I understand that regardless of my pet’s recovery or survival I agree to pay the CPR fee in addition to other fees already identified by the practice and agreed upon by me.
- I understand that despite the best efforts of the doctors and team members, CPR may not be successful.
Please choose one of the following: *
Microchip Implantation: *

Yes, I want and authorize a microchip implantation No, I do not authorize a microchip implantation No, my pet already has a microchip
Microchip number:
By typing my signature on the bottom of this page, I understand this to be my expressed and written consent for anesthesia and surgical procedures on my pet. *

Clear
Date *

Month Day Year
Date
COVID-19 Acknowledgement
For the protection of both our team and clients, have you been exposed to COVID-19 or know anyone who has or is currently experiencing symptoms? *

Yes- we can still perform surgery on your pet, please give us a call No
Have you traveled outside the United States of America or the state of Ohio within the last 2 weeks? *

Yes No
I understand that to help decrease the spread of possible contaminants, my pet's personal items, including but not limited to: collar, leash, carrier, cages, pet clothes, blankets, muzzles, etc. may remain in the vehicle and I allow Easton Animal Hospital to use their own items to transport and restrain my pets. *

I understand and agree.
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Anesthesia / Surgical Authorization Form

Anesthetic and Surgical Procedures to be Performed

COVID-19 Acknowledgement