Rabbit Treatment and Surgery Consent

Rabbit Treatment and Surgery Consent
Name*

First NameLast Name
Patient's Name*
Species*
Breed*
Age*
Items left with patient
PRE SURGICAL CHECKLIST: ALL BOXES MUST BE CHECKED; IF ANY BOXES DO NOT APPLY, PLEASE EXPLAIN ON THE LINE BELOW*

Patient has no history of seizuresPatient has no history of adverse drug reactionsPatient has been eating and drinking normally
If ALL checkboxes are unable to be checked, WHY?
SPECIAL NOTES: PLEASE READ EACH POINT #1-3. Check the check box underneath each point to indicate that you have read and understand each point
RABBITS CANNOT VOMIT, THEREFORE FASTING IS NOT MANDATORY OR RECOMMENDED. PLEASE CONTINUE TO FEED YOUR RABBIT THEIR FOOD AND WATER UNTIL ADMISSION INTO THE HOSPITAL ON THE DAY OF SURGERY.*

I have read and understand the above point.
RABBITS MUST EAT AND DRINK AS SOON AS THEY ARE AWAKE AFTER SURGERY. PLEASE BRING WITH YOU THEIR NORMAL HAY, FOOD, AND WATER BOTTLE/DISH SO THAT WE CAN PROVIDE THEM WITH FOOD AND WATER POST-ANESTHESIA.*

I have read and understand the above point.
IT IS ESSENTIAL THAT RABBITS EAT, DRINK AND DEFECATE NORMALLY WITHIN THE FIRST 24 HOURS POST-OP. BECAUSE OF THIS, PAIN MEDICATION IS REQUIRED FOR ALL RABBITS. PAIN MEDICATION WILL BE SENT HOME WITH YOUR PET TODAY - PLEASE BE SURE TO GIVE THIS MEDICATION AS DIRECTED.*

I have read and understand the above point.
PLEASE READ THIS SECTION CAREFULLY:
FLEA POLICY: Pets with fleas will be treated in the clinic at additional cost.

PAIN CONTROL: All patients undergoing a surgical procedure will receive pain medication, to be given at home, to ensure their comfort.

SURGICAL FOLLOW-UP POLICY: Surgeries that are not routine may require additional visits. There may be additional fees for these visits. We do not include these fees in the surgery cost since there may be more than one recheck.
CONSENT TO TREATMENT:
I am the owner or agent for the owner of the above-described animal and have the authority to execute this consent. I hereby authorize Heartland Veterinary Clinic to perform the procedure(s) listed above. I understand that during the performance of the foregoing procedure(s), unseen conditions may be revealed that necessitate an extension of the foregoing procedure(s) that are set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment. I also understand that I will be responsible for full payment of services at the time my pet is discharged from the hospital.

I have read and understand this authorization and consent, and being of legal age, I hereby consent and authorize this hospital and its veterinarians and staff to perform the agreed to procedures.

* I have been advised as to the nature of the procedure(s) and/or surgery and the risks involved.
* I accept that anesthesia always involves some element of risk to my pet.
* I understand that every precaution is practiced ensuring the safety of my pet before, during, and after the procedure.
ESTIMATES AVAILABLE UPON REQUEST
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Rabbit Treatment and Surgery Consent

SPECIAL NOTES: PLEASE READ EACH POINT #1-3. Check the check box underneath each point to indicate that you have read and understand each point

PLEASE READ THIS SECTION CAREFULLY: