Surgery Consent Form (Under 8 YRS Old)

Surgery Consent Form (Under 8 YRS Old)

To: Hickory Grove Animal Hospital and its Doctors;
Name*

First NameLast Name
Animal Name*
Breed*
Species*
Sex*

MaleFemale
Age*
I am the owner or agent for the owner of the above animal and have the authority to execute this consent. I hereby consent to and authorize the performance of the following procedure(s) or operation(s): *
*Extra fee(s) for in heat, pregnant (IV catheter & fluids for pregnant pets), and/or extraction(s)
I understand that during the performance of the foregoing procedure(s) or operation(s), unforeseen conditions may be revealed or arise that necessitate an extension of the foregoing procedure(s) or operation(s) or different procedure(s) or operation(s) than those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the veterinarian's professional judgment.

I also authorize the use of appropriate anesthetics and other medications. I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I also authorize the hospital and staff, in an emergency situation, to follow through with such procedures as are necessary for the well-being of my pet on a continuing basis until further communication
with me.
Please Initial the following:
My pet is not allergic to any medications
Please Initial one of the following
My pet is allergic to the following medications
Please Initial one of the following
My pet has not had any food/water according to recommendations*
Initials
I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I realize that no guarantee or warranty can ethically or professionally be made regarding the results or cure.

I understand that I assume financial responsibility for all services rendered and that any estimate will be only an estimate and only
for the procedure(s) initially discussed. Should further procedures or emergency treatment be required, I understand that I will be
financially responsible for those services rendered as well.

I have read and understood this authorization and consent:
Printed Name of Owner or Agent *
Please include date
Phone number where to reach you*
Please enter a valid phone number.
Signature

Clear
Pre-Anesthetic Testing Consent
Client Name*

First NameLast Name
Date*

MonthDayYear
Date
Patient Name*
Age*
Your pet is scheduled for a procedure that requires anesthesia. We would like to take this opportunity to recommend pre-anesthetic testing and explain why it is important to the health of your pet.

Like you, our greatest concern is the well-being of your pet. Before placing your pet under anesthesia, a veterinarian will perform a complete physical examination to identify any existing medical conditions that could complicate the procedure and compromise the health of your pet.

Because there is always the possibility a physical exam alone will not identify all of your pet’s health problems, we strongly recommend that a pre-anesthetic profile (a combination of tests) be performed prior to anesthesia. The tests we recommend are similar to and equally as important as those your own physician would run if you were to undergo anesthesia.

It is important to understand that a pre-anesthetic profile does not guarantee the absence of anesthetic complications. It may, however, greatly reduce the risk of complications as well as identify medical conditions that could require medical treatment in the future. There are additional fees for blood work and IV catheter fluids. Please check your estimate for further information.

The combination of blood tests we recommend for the apparently healthy younger pet (8 or less) is listed below:
*Chem10, CBC, and Lytes.
(PLEASE INITIAL ABOVE) To give permission
Please Initial either above or below for Permission:

I decline the recommended pre-anesthetic tests at this time and request you proceed with anesthesia. I understand that a medical condition may exist which would be impossible to identify during a physical exam alone. I understand that my pet’s health could be at risk if such a condition goes undetected when my pet is placed under anesthesia.
*Chem10, CBC, and Lytes.
(PLEASE INITIAL ABOVE) To decline test
*Intravenous catheter and fluids are required for all anesthetic procedures.*
I am aware that my pet will have an intravenous catheter and fluids for this procedure. (PLEASE INITIAL)
Microchipping is a means of permanently identifying your pet. We can perform this procedure today. If you would like to have this done, please indicate below:*

Please Microchip my petI decline microchipping for my pet
Owner Initial*
WE MUST BE ABLE TO CONTACT YOU THROUGHOUT THE DAY IN CASE OF EMERGENCY OR FOR ANY QUESTIONS WE MAY HAVE BEFORE OR DURING SURGERY.
Phone Number You Can Be Reached At Today:*
Please enter a valid phone number.
Should be Empty:

Surgery Consent Form (Under 8 YRS Old)

Please Initial the following:

Pre-Anesthetic Testing Consent

Please Initial either above or below for Permission:

WE MUST BE ABLE TO CONTACT YOU THROUGHOUT THE DAY IN CASE OF EMERGENCY OR FOR ANY QUESTIONS WE MAY HAVE BEFORE OR DURING SURGERY.