• Patient Surgery Admission Form

    Ivor Veterinary Clinic
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  • Owner / Client Details

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  • Due to the dynamic nature of our daily surgery and appointment schedules, phone calls with updates on surgery patients may be significantly delayed. Please don't hesitate to reach out to the clinic for an update if you haven't received a call from us by 4:30 P.M.

     

    Clinic Contact Information 

    Phone: 757 859 6415

    Text: 888 492 3601

  • Pre-Surgical Questionnaire

    Please answer the following questions to the best of your ability.

  • Surgical Information

    Please read through carefully & sign at the bottom of the form.
  • Anesthetic Procedures & Risks

    We use a combination of pre-anesthetic medications/injectables and/or inhalant anesthetics to achieve optimum levels of anesthesia that are safe for your pet. 


    For most procedures, your pet is anesthetized and then intubated (insertion of a tube into the trachea or windpipe). This ensures your pet receives oxygen at all times, and it prevents aspiration of any fluids into the lungs. Intubation allows us to maintain anesthesia with sevoflurane, a gas anesthetic, which is very safe and the body will not metabolize. This allows us more control over anesthetic depth and causes less airway irritation. 

    For procedures that require minimum sedation, an injectable anesthetic is given that produces a good plan of sedation with quick recovery and reversible with medication. 

    A risk of death is possible during or after a surgical, or anesthetic procedure.


    Monitoring and Pain Management

    Monitoring of patients during anesthesia is done in two ways. First, a veterinary technician/assistant is with your pet from the beginning of anesthesia to recovery. Second, we have computerized monitoring equipment that records heart rate, blood pressures, oxygen levels, respiration, ECG, and body temperature. Surgery patients will receive pain management before, during, and after surgery. Pain medications may also be prescribed to go home with the patient. Additional information will be given at discharge. We hope this will reduce any discomfort experienced by our patients and aid in a quicker recovery. 

  • Intravenous Catheterization & Fluids

    IV Catheters are required for all dentals under anesthesia and for patients over 7 years old. An IV catheter may be placed in patients undergoing major surgery. This helps minimize the risk of general anesthesia and provides us with direct IV access in case of an emergency. IV catheter placement also allows for IV fluid administration, as needed, during and after surgery. 

    (NOTE: We shave hair to place an IV catheter.)

  • Pre-Anesthetic Bloodwork

    In order to recognize any underlying abnormalities your pet may have, which may put that at greater anesthetic risk, we offer, and sometimes require, a pre-anesthetic blood profile to be run on your pet. This consists of a CBC (complete blood count) that checks blood cells, and a small chemistry panel that checks blood glucose, protein, and kidney/liver function. These tests help us assess your pet more completely and determine if there are any additional precautions we need to take prior to surgery. If your pet has already had bloodwork in the past 30 days, we will not need to repeat blood tests day of surgery unless deemed necessary by the surgeon. 

    Complete Blood Count (CBC) includes:

    • PCV (anemia)
    • white blood cell count (infection)
    • platelet count (clotting disorder)

    Pre Anesthetic Profile includes:

    • BUN and creatinine (kidney)
    • ALKP and ALT (liver)
    • glucose (sugar)
    • total protein (dehydration)

    Potential Surgical Complications

    • Spay: bleeding, infection, coughing, false pregnancy, urinary incontinence, and suture reactions. 
    • Castration (Neuter): bleeding, infection, scrotal swelling, coughing, and suture reactions. 
    • Mass Removal: bleeding, infection, swelling and drainage, coughing, and suture reactions. 
  • Anesthesia/Sedation/Procedure Authorization

    Please read, date, & sign
  • If anesthesia/sedation is required, I understand that there are risks involved and that in the event of an emergency, the hospital will take all necessary actions to control the problem and will notify me as soon as possible. I understand and agree to the use of human medicine in my animal when deemed appropriate by the Veterinarian. 

     

    The estimated cost of these procedures is between: $250 - $800
    I have read and fully understand that this is ONLY an estimate. Ivor Veterinary Clinic makes every effort to remain within the estimate given, but the actual diagnostic or treatment plan may require more diagnostics, medications, or procedures. The range of this estimate may vary by as much as 10% - 15%. 

     

    I agree to meet the costs of all treatment at the time of discharge. I understand the risks and complications of these procedures, which have been explained to me by the Veterinarian.

    All accounts are payable at the time of consultation unless a prior arrangement has been made.

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