Surgical Consent
Please read each section in it's entirety and ask a staff member if you have questions or concerns regarding consent for treatment. Thank you!
Date of Appointment
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Month
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Day
Year
Date
Client’s Name
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First Name
Last Name
Pet’s Name
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Phone Number
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Please enter a phone number you may be reached at today.
Would you prefer text or phone call communications about your pet while they are here?
Texts
Phone calls
What procedure is your pet here for today?
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Please Select
Spay
Neuter
Growth Removal
Sedation for other procedure
If your pet is here for a growth removal, please describe the location(s).
I am the owner or authorized agent for the animal above, am over 18 years of age, and I have the authority to sign this consent.
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Yes
No
I understand that there are certain risks and complications associated with sedation, anesthesia, and/or any operation/procedure. I further understand that during the course of the operations or procedures, unforeseen conditions may arise that may necessitate the performance of additional procedures deemed necessary by the veterinarian. I am encouraged to discuss any concerns I have about these risks with the attending veterinarian before the procedure is initiated.
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Yes
No
I authorize the use of appropriate anesthesia and pain relief medication as needed before, during or after the procedure. I have been informed that there are risks associated with the use of any medication.
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Yes
No
The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware that the practice of veterinary medicine is not an exact science and, thus, there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet's medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.
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Yes
No
Pre-surgical Bloodwork Consent: We encourage all patients undergoing any procedure involving anesthesia to have pre-anesthetic bloodwork. This bloodwork gives the doctors additional information regarding your pet's ability to metabolize and safely recover from anesthesia. This bloodwork also allows the doctors to determine if you pet has an underlying condition that may inhibit the ability to recover safely. If I decline this bloodwork, I understand that the doctors may not be able to intervene appropriately should my pet have an adverse anesthetic event. The cost for pre-anesthetic bloodwork is an additional $160.00.
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Accept
Decline
My pet has already had blood work performed within the last 30 days.
CPR Consent: Although adverse reactions to anesthesia are rare, in the event that your pet should experience cardiac or respiratory arrest while being hospitalized today, do you give consent for resuscitative efforts to be initiated until you can be contacted and notified of your pet’s status? By consenting to this service, you are also acknowledging that certain fees will apply. If you are not available to be contacted immediately, resuscitation efforts will continue to be performed at the doctor's discretion.
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Accept
Decline
Cold Laser Therapy Consent: I would like my pet to receive laser therapy to their incision after surgery. Cold Laser therapy helps to speed up healing time and reduce pain and inflammation in the incision. The cost for this is $10.00.
Accept
Decline
Check additional service you would like performed today:
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Vaccinations-prices vary
Nail trim-$10.00
Anal gland expression-$15.00
Microchip insertion/registration-$45.00
Extract baby teeth-$15.00/tooth
Ear cleaning-$15.00
None
Signature
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Submit
Should be Empty: