Spay/Neuter Surgery Consent Form

Name*

First NameLast Name

Pet's Name*

Pet's Name

Email*

example@example.com

Phone Number*

Phone Number Emergency*

Date of Procedure*

Date

What procedure is your pet here for?

Your pet should be fasted (not given food) after 9pm the night prior to the procedure. Water is OK and should not be restricted*

Yes, I understand

Are there any health concerns with your pet that you want our veterinary staff to address? (ear infection, lameness)

A microchip helps identify your pet should it get lost and also allows you to get a lifetime registration license for your county.

The cost of microchip/implantation is $125.

https://www.homeagain.com/microchipping.html#video

Benefits of a HomeAgain microchip

Your pet's microchip will be permanently registered in the National Pet Recovery Database.
Access to an around-the-clock Lost Pet Specialist to guide you through the process of searching for your lost pet
Recovery Specialists send rapid Lost Pet Alerts to the network of veterinarians, shelters and PetRescuers in the area your pet went missing.
Access to a 24-hour hotline and APSCA poison control staffed with licensed ASPCA veterinarians
Lost pets found 500 miles from home can receive up to $500 in pet airfare to fly your dog or cat back home.

Do you want a microchip placed in your pet?*

Yes, place a microchipNo, I accept the risks of not having my pet microchippedNo, my pet is already microchipped

Retained deciduous teeth, commonly seen in young pets, occur when the permanent teeth fail to displace the temporary teeth. The permanent tooth and deciduous teeth occupy the same location, causing crowding and damage to the permanent tooth. Dental crowding can also lead to rapid plaque accumulation. Retained deciduous teeth should be removed.

Missing permanent teeth is also a common problem. Missing teeth should be x-rayed to rule out the possibility of a retained or trapped tooth. A trapped tooth below the gumline can lead to a destructive, dentigerous cyst. Trapped teeth should be surgically removed.

If my pet is missing teeth or has retained baby teeth, I authorize the veterinarian to take necessary dental x-rays and/or remove the baby teeth to protect my pet's oral health. I understand that this will be an additional charge.*

Yes, I consent to this dental intervention if oral exam reveals retained or missing teeth, and I understand that this has additional costs.No, I do not consent and understand that I will need to speak to a veterinarian at the time of patient drop off.

If your pet is due for any vaccines, do you want us to provide them at the time of the procedure?

YesNo

Preventatives

Dogs and cats should receive monthly preventatives to protect them from tick-borne disease, intestinal parasites, heartworm disease, and flea-borne diseases. The preventatives your pet receives also decreases the risk to your family from flea/tick/parasite exposure.

Yes, please refill my pet's preventative medication. Indicate which product and how many doses you would like

What to expect on the Day of the Procedure

Please drop off your pet between 8am - 830am.
Your pet will be greeted by one of our veterinary nurses. This nurse will be responsible for your pet's care and comfort for the entire day.

A doctor will complete a thorough physical exam and perform preanesthetic bloodwork prior to the procedure
The order of procedures will be triaged that morning, with the most critical patients receiving intervention earlier in the day.

Every patient under general anesthesia will have an IV catheter and IV fluids to maintain IV access, blood pressure and hydration.

During the anesthetic procedure, your pet's nurse will be monitoring blood pressure, pulse oximetry (oxygen levels), ECG (heart rate and beat), and temperature.

Your pet's nurse will stay with your pet through recovery from the procedure.
Our doctors/nurse will call you when your pet is in anesthetic recovery and provide you with a summary of the procedure and when your pet will be discharged.

I have received an estimate for the procedure and understand that payment is due at the time or service.*

Yes, I received an estimate for the procedure.No, I have not received an estimate for the procedure.

By signing below, I certify that I am the owner or agent of the owner of the above named pet and I have the authority to make medical decisions related to the pet. I authorize the Devon Veteryinary Staff to provide care and perform any treatment they consider reasonable and necessary for my pet.

I understand that payment in full is required at the time of service. DVH will provide an estimate of fees upon my request. I acknowledge that an estimate is only an approximation; actual fees may vary. I recognize that I am responsible for all charges related to my pet.

I understand that risks exist with anesthesia and/or surgery and that I am encouraged to discuss an concerns I have about those risks with the attending veterinarian before the procedure is initiated.

Signature*

Spay/Neuter Surgery Consent Form

Microchip

Dental Assessment