Anesthesia & Surgical Consent

Hospital Hours : 7:00am to 6:00pm Monday - Friday.

Your Name*

First NameLast Name

Your Pet's Name*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Would you like us to text you updates during your pet's procedure?*

YesNo

It is our goal for each patient to have the safest, most stress-free experience possible. We follow the American Animal Hospital Association's highest surgical standards for the safety and comfort of your pet. All pets scheduled for general anesthesia have a preoperative exam and blood panel performed. This assesses basic metabolic function, complete blood count, and liver and kidney values. It allows us to ascertain there are no underlying issues with organ function, blood imbalances, or anemia that could cause complications. If problems are found which may significantly increase the risk of anesthesia or warrant additional care, these problems will be discussed with you prior to proceeding.

Your pet's past anesthetic history, breed, pre-existing conditions, and age are all factors used to determine your pet's personalized anesthesia protocol. Cardiopulmonary (heart and respiratory) monitoring equipment is used in all extended procedures as an added precaution. An IV solution will be administered while your pet is under to ensure proper electrolytes and hydration – this will require shaving a section of one or two legs. We will utilize the proper surgical medications to keep your pet comfortable and pain-free.

Surgical admission is 7:00-8:00 AM and is designed to reduce your pet’s anxiety and allow for pre-anesthetic examination and testing. Please feel free to contact us at any time for an update on your pet at 770-476-3317.

Did your pet eat this morning?*

YesNo

Has your pet had a past reaction to vaccines, medications, or anesthesia?*

YesNo

If you answered yes to the above question, please explain :

Is your pet currently taking any medications or supplements?*

YesNo

If yes, please list :

Would you like your pet microchipped today? ($59.80)*

YesNo

Would you like an estimate of the fees for today's visit? (Although we make every effort to adhere to any estimate given, please understand this is NOT a guaranteed quote of final cost. Actual costs may vary according to your pet's needs, and these can change unexpectedly during a procedure.)*

YesNo

I understand there are always inherent risks with the use of anesthesia, and that Duluth Animal Hospital takes every precaution to lessen these risks. I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated.

I understand that the veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff has my permission to proceed with life-sustaining procedures.

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 assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams 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.)

Although every effort to adhere to any estimate given, I understand that actual cost may vary according to your pet’s individual medical needs. Estimates are NOT a guarantee of final cost, and I will be responsible for any costs beyond the original estimate provided.

I understand full payment is due at the time of service by credit or debit card, Care Credit, or cash. Checks are not accepted.

I have requested the above services performed by Duluth Animal Hospital, and I authorize Duluth Animal Hospital to charge me for these services. I have read and fully understand the terms and conditions set forth above. I am the owner of or an authorized agent of the pet and at least 18 years of age and I have exclusive authority to authorize this treatment. (signature)*

Anesthesia and Surgical Consent Form

Your Pet's Medical History

Pre-Anesthetic Agreement