Anesthesia / Sedation Consent Form

    Our greatest concern is the well being of your pet. A comprehensive physical examination gives our doctors much important information about your pet. However, conditions such as dehydration, anemia, infection, diabetes, and or kidney or liver disease may not be detected without a pre-anesthetic blood profile. These conditions may necessitate changes in the way the procedures are performed in order to maximize your pet’s health. Indeed, the discovery of a medical condition through pre-anesthetic blood and urine analysis may even necessitate the postponement of an elective surgical procedure until the medical condition can be treated. In an effort to maximize anesthetic safety patients receive thermal support and pulse oximetry monitoring during anesthesia. Patients who are anticipated to be under general anesthesia for more than 30 minutes also receive IV catheters and IV fluids for cardiovascular support.

    We recommend that a pre-anesthetic blood profile be performed on every patient. These tests are similar to those that your own physician would run if you were to undergo anesthesia. In addition, the results of these tests will go into your pet’s permanent health record, providing a “baseline” for comparison as your pet’s health changes throughout his or her life.

    Because serious changes in a patient’s health occur more frequently as the patient grows older, we require all patients over the age of 7 years to have complete bloodwork and urinalysis prior to any anesthetic procedure. To maximize the safety of anesthesia, we also require that these patients receive an IV catheter and IV fluids during their procedure.

State of the art equipment enables us to perform the pre-anesthetic blood profile at our hospital on the same day your pet is scheduled to undergo anesthesia.

In addition to the above tests, we will also evaluate:
*Albumin (Liver, protein)

*Phosphorus (Kidney)

*Calcium (Kidney, tumors)

*Total Bilirubin (Liver)
*Amylase (Pancreas)

*Cholesterol (Kidney, Liver, pancreas, thyroid)

I understand that the doctors of Village Veterinary Medical Center will be performing pre-anesthetic bloodwork to maximize the safety of the procedure for my older pet. If abnormalities are found, please contact me via the listed phone number.

To maximize patient comfort, all patients will receive pain medication prior to and following surgical procedures. Additional pain medications will be administered as deemed necessary by the attending clinician. I understand I am responsible for any costs associated with pain management for my pet.

As the owner, or agent of the owner, of the animal above, I hereby give my consent to Village Veterinary Medical Center to perform surgery and/or treatments to my pet. I understand that during the performance of this procedure, unforeseen conditions may be revealed that necessitate an extension or variance in the procedure. I expect Village Veterinary Medical Center to use reasonable care and judgment in performing the procedure(s).

I also understand that extraction of teeth may be necessary if there is severe gum or tooth disease, or if baby teeth have not come out on schedule.

While I expect all procedures to be done to the best of the abilities of the professional staff, 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. Payment is due in full at the time services are rendered. A written estimate will be provided upon request