Anesthesia Information and Consent

Like you, our greatest concern is the well being of your pet. Prior to anesthetizing your pet, our doctors will perform a complete physical examination. In addition, the following measures are taken for every surgical patient.

Surgical Requirements:

An intravenous (IV) catheter is required for all anesthetized patients. Catheter placement enables us to administer IV fluids during the surgical procedure, helping prevent low blood pressure and dehydration in your pet. It also allows for the administration of any pain medications, antibiotics, or emergency drugs if necessary.

Anesthetic monitoring is performed by our trained staff, using the best technology available. Heart rate, blood pressure, electrocardiogram, core body temperature, pulse oximetry, end tidal CO2, and respiratory rate are some of the specific parameters we monitor. These vital signs are continuously assessed to help create the safest anesthetic environment possible.

The control of pain is a very important aspect of the surgical procedure. Our goal is to minimize the inherent discomfort associated with all surgical procedures. A pain free animal requires a lower level of anesthesia, increasing the safety for your pet and helping to ensure a smooth and speedy recovery. Our pain management protocol is required in all surgical patients. The medications used and length of treatment will vary based upon the procedure performed and the degree of pain involved.

Surgical Options - please select choices below:

Microchip implantation (911 pet chip): Microchipping is available and can easily be placed into your pet by injection. The chip is the size of a grain of rice and will permanently identify your pet in case they are ever lost. A handheld scanner identifies the number which, after registration, is permanently traceable to the owner.

Today's Date

MonthDayYear

Name of Pet

Anesthetic Procedure(s) to be Performed

Primary Phone Number

Area CodePhone Number

Additional Phone Number (If I cannot be reached at the primary phone number)

Area CodePhone Number

Email

example@example.com

I authorize permanent identification in the form of a 911 Microchip to be implanted in my pet while they are here for anesthesia. If your pet already has a microchip, we will not be implanting a second one. ($25)

I would like these additional procedures to be performed during my pet's visit. I understand these procedures may incur charges beyond what I was estimated for the original procedure.

Other

Does your pet have a history of seizures or other neurologic disorder?

Do you have any additional concerns or questions for the anesthesia team?

Please list the medications you give your pet, and the last time they were given.

Rows	Name and Dose	Frequency Given	Time Last Given	Date Last Given
Medication
Medication
Medication
Medication

Name

First NameLast Name

I understand that payment for this procedure and any services at Hilliard Veterinary Hospital is required the day they are performed. I understand that I will receive/sign an estimate at the time of check in and it is a living document and it is subject to be changed throughout the day, based on new information gathered after anesthesia is achieved (such as dental radiographs, abdominal exploratory, etc). I understand that the anesthesia team will be in contact with me during the day as new conditions arise.

By signing below with my finger or mouse, I attest that I understand the procedure to be performed on my pet and have no further questions at this time. I acknowledge there may be concealed health risks to my pet and release Hilliard Veterinary Hospital and staff from any unforeseen complications arising from anesthesia/surgery. I will be available at the phone number(s) listed below at all times during the day of the procedure. If the doctors and staff at Hilliard Veterinary Hospital cannot reach me by phone, I agree to allow any treatment deemed any life saving treatments for the health of my pet.