Spay/Neuter Client Consent Form

Email Address*

example@address.com

Client's Name*

First Name Last Name

Pet's Name*

Name

Phone Number*

Your pet should be fasted (not given any food) after 9 PM the night before the procedure. Water is okay and should not be restricted.*

Yes, I understand and will fast my pet after 9 PM the night before the surgical procedure.

Are there any health concerns with your pet that you want our veterinary staff to address?*

Your answer

Microchip

A microchip helps identify your pet should it get lost and also allows you to get a lifetime registration license for your county. This saves you money instead of registering your pet every year if they are not micro-chipped. The cost of a microchip is $80.40. To learn more about the importance of micro-chipping your pet, please visit: http://www.pethealthnetwork.com/dog-health/dog-checkups-preventive-care/microchipping-101-why-it-important-microchip-my-pet

Do you want a microchip placed in your pet?*

Yes, place a microchip.No, I accept the risks of not having my pet microchipped.No, my pet is already microchipped.

Dental Assessment

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 x-rays and/or remove the baby teeth to protect my pet's oral health.*

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 protects your family from flea/tick/parasite exposure.

Do you need a refill of your pet's flea/tick and heartworm preventatives? If so, please let us know which product and how many months you would like. *

Your answer

What to expect on the Day of the Procedure

Please drop off your pet between 8:30am-9am.

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.

Treatment Authorization

I understand that risks exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated.To better understand our anesthesia protocols at our hospital please visit the anesthesia page of our website: https://www.douglassvillepets.com/anesthesia.html

By checking the box 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 Douglassville Veterinary Hospital staff to provide care and perform any treatment (including the administration of anesthesia and surgical procedures) they consider reasonable and necessary for my pet.*

I agree to the statement above.

Acceptance of Financial Responsibility: I understand that payment in full is required at the time of service. Douglassville Veterinary Hospital staff 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 agree to the statement above.

Signature