• Animal Medical Center Copperas Cove Hospitalization/Surgery Form

  • PLEASE READ CAREFULLY BEFORE SIGNING THIS DOCUMENT

  • I understand that my pet is being left in the medical care of Animal Medical Center Copperas Cove, its veterinarians and staff. I further understand that every effort will be made to ensure my pet’s safety and comfort. I hereby authorize the use of anesthesia for any procedure or treatments performed in the care of my pet. I further authorize any and all necessary surgical operations and/or medical treatment as they may decide necessary or advisable upon my pet. Some veterinary procedures need to be performed with your pet under anesthesia (for example: dentistry, surgery, and some diagnostic imaging Like any medical procedure, anesthesia does have risks. These risks can run from minor problems, such as mild vomiting after recovery from anesthesia, to life-threatening problems such as cardiac arrest or stroke. Anesthesia related deaths are rare, and while complications can occur, the veterinary team will take all of the necessary precautions to ensure that your pet is safe and can handle anesthesia.

    My pet will have pre-anesthetic blood testing done today ($92.70 charge)

    ADDITIONAL CHARGES 1. POST-SURGICAL PAIN RELIEF MEDICATIONS WILL BE SENT HOME. THE COST OF THIS PAIN MEDICAITON IS ESTIMATED AT $22.00-$60.00 2. REGARDING SPAY PROCEDURES: THERE IS A MINIMUM ADDITIONAL CHARGE OF $50.80 IF YOUR PET IS IN HEAT OR IN EARLY PREGNANCY. IF YOUR PET IS IN LATER STAGES OF PREGNANCY, THIS CHARGE MAY BE HIGHER. 3. DURING THE PRE-SURGICAL PHYSICAL EXAM, WE SOMETIMES FIND THAT YOUNGER ANIMALS HAVE DECIDUOUS TEETH THAT SHOULD BE EXTRACTED TO PREVENT PROBLEMS LATER ON. I GIVE MY PERMISSION FOR THE DOCTORS TO USE DISCRETION FOR EXTRACTIONS MY PET MAY NEED. MINOR EXTRACTIONS ARE AN ADDITIONAL CHARGE OF $49.30. 4. I FURTHER UNDERSTAND THAT MY PET WILL BE INSPECTED FOR EXTERNAL PARASITES UPON CHECK-IN. IF EVIDENCE OF FLEAS, TICKS, EARMITES, OR SARCOPTIC MANGE IS FOUND, MY PET WILL BE TREATED AT THE HOSPITAL’S DISCRETION AND APPROPRIATE CHARGES WILL BE ADDED TO MY ACCOUNT.

  • OTHER PROCEDURES

  • Consent/Decline CPR incase of Cardio Pulmonary Arrest.

  • I elect endotracheal intubation, positive pressure respiration, administration of emergency drugs, and or external cardiac massage. I elect NOT to have staff pursue any CPR procedures for my pet. I request that the Veterinarian assist my pet in humane euthanasia if treatment will only prolong pain and suffering.

    I am the owner/guardian of this pet and I am over the age of 18 years of age and can legally make medical decisions regarding this pet

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