Broadmoor East Spay/Neuter Surgery Consent Form
Owner Name
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First Name
Last Name
Patient Name
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Enter the name of your pet
Phone Number where you can be reached while your pet is in our hospital today.
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Please enter a valid phone number.
Format: (000) 000-0000.
Procedure to be performed:
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Spay (Female Pets)
Neuter (Male Pets)
My Pet is a:
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Dog
Cat
Other
Date Surgery Is Scheduled to be performed
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Month
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Day
Year
Please select the date your pet is scheduled for surgery
Pre-Surgical Blood Testing
Your pet is being admitted for a surgical procedure to be performed under general anesthesia. Our doctor will perform a physical exam, checking your pet's vital signs to evaluate your pet’s health prior to surgery. However, some conditions and illnesses cannot be detected during a physical exam. Pre-surgical bloodwork will help minimize the risks during anesthesia and surgery. By testing blood chemistries and hematology values, we can better evaluate the status of your pet's health and anesthetic risk factors. Our doctors strongly recommend these tests for all surgical patients.
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Yes, I consent to having pre-surgical blood testing done at a cost of $132
No, I decline to have pre-surgical blood tests done.
Permanent Identification
Microchip Implants
If your pet does not already have one, we can implant a microchip at the time of surgery. Microchips are strongly recommended for ALL pets to ensure their best chance of being returned should they ever get lost. Our microchips include a lifelong registration.
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Yes, I consent to having a microchip implanted at a cost of $53.
No, do not place a microchip implant.
My pet is already microchipped.
Anesthetic Monitoring
We are proud to utilize sophisticated monitoring systems (blood pressure, pulse oximetry, and EKG) during surgery. Your pet’s vital signs will be closely monitored by one of our caring and highly trained anesthesia technicians working closely with our surgeon.
I have read and understand the statement above.
Pain Management
We recognize that pets recovering from surgery feel pain and experience stress. Our doctor will give your pet appropriate analgesic (pain relieving) injections and/or oral medications to keep your pet comfortable following surgery. All pets are recovered in warm, comfortable areas, under the watchful eye of our staff members, and most are able to return home the same day.
I have read and understand the statement above.
Required Treatments
Core Vaccinations
For the safety of our patients and staff, all pets admitted to Broadmoor East Veterinary Clinic for surgery must be up to date on Distemper (DHPP, or FVRCP) and Rabies vaccines. If your pet's vaccines are expired, or you cannot show documentation to prove these vaccines are up to date upon admission, we will administer these vaccines while your pet is here for surgery, at your expense. Rabies $37, Dhpp/FCRCP $46.
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I have read and understand the statement above.
Post-Operative Sedatives (Dogs Only)
Restricted activity is required for at least 10 days following your pet’s surgery, in order to allow for optimal healing, and to prevent complications. This can be difficult for our young/active/energetic canine patients. We offer an oral medication that acts as a "chill pill" and helps your pet calmly handle this period of restricted activity. This is very safe and effective for dogs, and can help prevent post-surgical complications which may incur additional charges. Our veterinarians will evaluate each pet to ensure this is a safe, suitable option. Would you like our doctor to prescribe this medication for your pet today?
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Yes, please send my pet home with a post-op sedative.
No, I do not want my pet to be sent home with a post-op sedative.
E-Collars
The "Cone"
E-Collar: It is imperative that your pet does not lick or chew at his/her incision until completely healed. We offer E-Collars to help prevent your pet from causing damage to their surgical site. Would you like an e-collar to take home after surgery?
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Yes, please send my pet home with an e-collar.
No, I do not want my pet to go home with an e-collar.
I already have an e-collar at home.
In-Heat or Pregnant (Female Pets Only)
If your female pet is either in-heat or pregnant at the time of her Spay surgery, there is an elevated risk of surgical complications, and less desirable surgical outcomes, and the surgery will take more time to complete. If you would prefer to postpone surgery until your pet is no longer in-heat or pregnant, we would be happy to reschedule your appointment. If you would prefer to go forward with the spay while your pet is in-heat or pregnant, additional fees will be assessed. In-heat: $50 Pregnant: $78
Yes, I would like my pet to be spayed, even if she is in-heat or pregnant.
I would prefer to reschedule my pet's spay surgery when she is no longer in-heat/pregnant.
My pet is not in-heat or pregnant.
Cryptorchid (Male Pets Only)
A condition in which one or both of the testes fail to descend from the abdomen into the scrotum
If your male pet has one or more testes that have not descended into the scrotum (Cryptorchid) at the time of their Neuter surgery, additional fees will apply, as these situations require a more involved surgical procedure than a typical neuter. Cryptorchid fees range from: $50 to $95.
I understand that additional fees will be assessed if my male pet has one or more undescended testicles.
Obesity
Obesity can cause and/or exacerbate a number of health conditions and can increase risks under anesthesia. Additionally, an excess of adipose tissue (fat) in the abdomen can make surgery more difficult to perform, and cause your pet to be under anesthesia longer. Additional fees may apply.
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I have read and understand the statement above.
Anesthetic and Surgical Risks
All anesthetic and surgical procedures entail some degree of risk, which we want you to be aware of. These risks include adverse reactions to anesthetic drugs; heart, respiratory or blood pressure abnormalities; abnormal or slow recovery from the drugs used ;and, in the worst cases, death under anesthesia. Surgical complications can include abnormal bleeding, infection, dehiscence (when the incision pulls apart), reaction to suture materials or damage to the incision from the pet licking, chewing or rubbing.
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I have read and understand the statement above.
Consent
I acknowledge that I will be responsible for any fees incurred for additional treatments, medications or surgical correction caused by my pet licking or chewing at the incision, or failing to follow our post-operative recovery instructions.
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I have read, understand and agree to the statement above.
By signing below, I hereby authorize Broadmoor East Veterinary Clinic to perform the listed procedures, and I fully understand the risks involved and realize that the results cannot be guaranteed. I am the owner of this animal (or agent for the owner) and have full authority to execute this consent. I further request and authorize any emergency treatment that is needed while my pet is under the care of Broadmoor East Veterinary Clinic. I understand that full payment for all services rendered will be due on the day of the animal's release from the hospital.
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Please enter your name above and sign below to acknowledge that you have read, understand, and agree to the above statements.
Signature
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