AAH Anesthesia/Surgical Consent

Aardvark Animal Hospital Anesthesia/Surgical Consent
OWNERS NAME*
PETS NAME*
SPECIES*
AGE*
Anesthesia/Surgical procedure to be performed:*
Date of Admission/Surgery*
Pet Information

Please answer the questions below regarding your pet.
YESNO
If yes, please explain.
YESNO
If yes, please explain.
When did your pet last eat or drink?*
What time did your pet last eat or drink?
YESNO
If yes, please explain.
YESNO
YESNO
Owner Information

Our hospital will contact you prior to surgery and when your pet recovers from anesthesia. Please be sure you are available for these important phone calls or Pet Desk notifications.
Today's Contact Person*

First NameLast Name
Phone Contact (1)*

Area CodePhone Number
Today's Secondary contact

First NameLast Name
Phone Contact (2)

Area CodePhone Number
YesNo
Authorization and Consent
I, the undersigned owner or agent of the pet identified above, authorize the staff of Aardvark Animal Hospital LLC to perform the above procedure.I am the owner of the animal, or have permission to act on behalf of the owner, and I am over 18 years of age.I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.A complete physical exam will be performed on your pet prior to the surgical procedure if it has been longer than 30 days since the last exam. However, this may not identify all systemic or metabolic problems. For this reason, your pet will have a pre-anesthetic blood panel to evaluate major organ functions prior to anesthesia.While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams, associated treatment, additional medications, and additional surgery due to post-op complications. These are more likely to occur when there is a failure to comply with the aftercare instructions.I am aware that the treatment plan provided is an estimation only for procedures on this given day. I acknowledge the scope of the treatment plan and estimate, and I understand that actual charges may differ depending on my pet's medical needs and response to treatment. Aardvark Animal Hospital LLC agrees to make every reasonable effort to stay within the fees set forth in my treatment plan and to contact me should additional charges be deemed necessary. I agree to pay in full at the time my pet is discharged and, in the case of nonpayment, a reasonable fee per month will be charged. All collection and attorney fees necessary to collect this debt will be born to me.I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life sustaining procedures.YesNo
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Aardvark Animal Hospital Anesthesia/Surgical Consent

Pet Information

Owner Information

Authorization and Consent