Surgical Consent Form

I understand that additional findings may be discovered during anesthesia or surgery that were not apparent during the initial examination. If an unexpected condition is discovered, I authorize the veterinarian and the veterinarian team at Northpark Animal Hospital to perform additional procedures that are reasonably necessary to protect my pet's health or life, provided that such procedures are within the veterinarian's professional judgment and do not substantially change the nature of the planned procedure.

 

If additional procedures are recommended that are not medically urgent, the veterinary team at Northpark Animal Hospital will make reasonable efforts to contact owner/representative for authorization when possible to the phone number provided.

 

I understand that I will have 5 minutes from the time I am successfully reached or contacted to provide authorization for the recommended procedure as the pet is under anesthesia and decisions must be made quickly to minimize anesthesia time for safety.

If I cannot be reached, do not answer, or callback within the designated time period, the additional procedure will not be performed and may require pet to undergo a second anesthetic procedure and treatment at a later date.

I understand that additional cost will be associated with a second anesthetic procedure due to my failure of responding in appropriate time and that I will be financially responsible to pay.

I authorize the extractions of compromised, fractured, abscessed/ infected or decaying teeth at the doctor’s discretion and understand that is an additional cost that may not have been reflected in my estimate that was given. I also authorize extractions of baby teeth.

I confirm that my pet has been fasted for 8 hours prior to procedure to reduce aspiration complications during the procedure.

I would like to be contacted prior to extractions of any diseased or residual baby teeth to discuss recommendations and understand the above 5 minute time window rule will apply.

I confirm that my pet has been fasted for 8 hours prior to procedure to reduce aspiration complications during the procedure.

 

 PRE-ANESTHETIC EVALUATION & TESTING

I understand that anesthesia/surgery carries inherent risks including but not limited to:

· Abnormal heart rhythm/Low blood pressure/Respiratory complications

· Suture reaction/ Dehiscence (opening up of surgical site)

· Rejection of implants

· Surgical site bruising

· Aspiration

· Allergic or adverse drug reactions

· Prolonged recovery

· Neurologic complications/ Organ dysfunction

· Anesthetic death

· Infection

· Oral and Nasal Bleed

· Dehiscense of oral surgical site

· Ocular Discharge

· Need for additional treatment or surgery

· Bleeding or hemorrhage /Blood transfusions

· Swelling, seroma, or inflammation

· Pain or discomfort/ Delayed healing

· Need for additional treatment or surgery not listed

· Unexpected complications or organ damage not listed

I understand if my pet is in estrus or estrus is diagnosed upon examination of pet an additional charge will be added to my invoice at checking out. If my pet is in estrus or recently out of estrus risk of infection and bleeding are higher.

I understand that serious complications can occur even in apparently healthy animals.

I authorize the veterinarian to perform a pre-anesthetic physical examination, pre-anesthetic bloodwork, and any recommended diagnostic testing necessary to assess my pet's anesthetic risk.

I understand that declining recommended testing may increase the risk of anesthesia complications and may limit the veterinarian's ability to identify underlying disease before anesthesia.

I understand that even if the veterinary and veterinarian team at Northpark Animal Hospital perform examinations and testing this does not completely eradicate pre, during, or post-surgical complications.

I authorize the administration of pain relieving medication and anti-nausea post- procedure as deemed necessary by the the veterinarian and their team and understand this may incur an additional charge.

If needed, the extraction of baby teeth or diseased teeth is authorized (Yes/No) If “No” I understand that retained deciduous (baby) teeth can lead to the infection and decay of adjacent adult teeth if not removed.

 

If needed, the placement of a microchip is authorized (Yes/No). This service will incur an additional fee. I authorize a nail trim (Yes/No) this item is offered for free when under anesthesia. Keep in mind, some counties require microchips on all pets

Northpark Animal Hospital (NPAH) agrees to allow the veterinarian to give such medical, surgical, or emergency treatment as its veterinarians deem necessary. Owner/agent acknowledges that patient is under the care of the veterinarians employed by NPAH and hereby consents to any treatment or services deemed necessary.

If patient is admitted to NPAH I understand and agree to treatment for external parasites, (e.g. fleas or ticks), and agree to pay for the treatment if deemed necesarry

If patient is admitted by NPAH and is on medication, there will be an additional charge for the administration of medications.

As owner/agent hereby authorizes NPAH to release information from patient's records to any person, agency, or authority as the veterinarians may determine necessary.

I have been advised as to the nature of the planned procedure(s) and the risks involved. I understand that results cannot be guaranteed. I understand that I am the financially responsible person, agree to pay upon discharge of patient and all charges incurred during treatment, care and procedure.

I have read and understand this authorization and consent.

This agreement shall remain in effect until such time as a different agreement is executed.