AUTHORIZATION 

I certify I am the legal Owner (or Authorized agent for the owner, at least 18 years or older) of the above named animal and voluntarily authorize the above procedure to be performed. 

I authorize the use of sedation, anesthesia and other medications as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. I have been advised as to the nature of this procedure to be performed and the risks involved. I understand that there is no such thing as a simple anesthetic procedure and that there is always a risk associated with any sedation or anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. 

While I accept that all procedures will be performed to the best of the abilities of the veterinarians and staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. 

I understand that any estimates provided for such procedures are for non-complicated procedures and that any unforeseen complications may result in additional costs. 

I understand that it may be necessary to provide medical and/or surgical intervention, which were not anticipated for the safety or care of my pet. I hereby consent to and authorize the performance of such altered and/or additional procedures as are necessary in the veterinarian’s professional judgment. I accept responsibility for any result in additional charges.

Please initial here if you do not consent to proceed with life sustaining procedures. ___

I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. 

I understand no staff will be attending to my pet overnight (pets needing special care may be referred to a 24 hour hospital). Any referral or stay at a different facility may results in additional costs that will be the owner’s responsibility. 

I also assume full responsibility for any additional expenses incurred after the surgical procedure is performed, such as follow up radiographs, re-check physical exams and additional surgery due to post-op complications.  These are more likely to occur when there is a failure to comply with the aftercare instructions.

If yes, please provide their information:

I have read and fully understand the terms and conditions set forth above, and by signing agree and fully understand all of the procedures and complications that may be involved with my pet undergoing surgery or anesthesia. If I do not receive discharge instructions I have been advised to return immediately. 

Pre-Surgical/Pre-Anesthetic Exam, Testing and Surgical Information 

PLEASE READ CAREFULLY. 

The well-being of your pet is very important to us and our greatest concern. Anesthesia or sedation will be required to perform today’s procedure on your pet. 

Prior to the anesthesia/sedation your pet will receive a basic physical exam by our veterinarian. This exam will allow certain medical conditions to be identified that could complicate today’s procedure or other procedures moving forward, and compromise the health of your pet. A physical exam alone may not identify all systemic or metabolic problems that your pet may or may not have. Therefore, we strongly recommend your pet have a pre-anesthetic blood profile performed prior to any anesthetic procedure in order to further evaluate major organ functions. The blood profile will allow us to assess level of hydration, presence of infection, anemia, blood glucose and electrolyte status as well as changes to liver or kidney values, which is important, since these organs are often involved in metabolizing the drugs we use for anesthesia/sedation. By knowing certain parameters we are able to adjust protocols and medications needed to follow the most appropriate and safest anesthetic regime possible. Please be advised that normal results in no way guarantee a successful outcome of the procedure or anesthesia. Chest radiographs and abdominal ultrasound are highly recommended in senior patients >7 years of age. We encourage you to discuss these recommended diagnostics with your veterinarian. 

Intravenous catheters and fluids are used for most procedures. IV catheters allow for fluid and drug administration, and give us a direct access to the circulatory system in case emergency drugs need to be administered.  IV fluids will aid in maintaining blood pressure and anesthetic recovery. We will need to shave a small amount of fur on the front leg(s) in order to safely place the catheter. Your pet will likely go home with a small bandage on the front or back leg, which will need to be removed once you get home. If this has not been addressed with you, please reach out to the staff prior to leaving. 

Your pet will likely receive a combination of injectable and inhalant medications to facilitate optimal levels of anesthesia and to prevent and treat any pain that is present or might arise from the scheduled procedure. We may or may not use an endotracheal (breathing) tube during the procedure. This is used to aid in breathing by delivering oxygen and protects the airway from debris and fluids that might be present in the mouth. There can be a mild cough associated with the placement of a breathing tube up to 48 hours post surgery. If you have further questions please discuss this with the staff. 

Your pet will be closely monitored throughout the anesthetic or sedated procedure, by our experienced technical staff, who will use our state of the art equipment to monitor heart rate and rhythm, ECG, breathing rate, oxygen levels, blood pressure, as well as core body temperature. We utilize a circulating warm air system and temperature controlled surgical tables to maintain core body temperature. 

Pain prevention and treatment of pain is of utmost importance to us and we utilize multiple modalities to minimize any pain your pet could experience prior to, during and after any surgical or non-surgical procedure. 

There are several post-surgical risks for common procedures. Please follow the directions of the staff to minimize these risks and do not hesitate to ask any questions regarding the post-op care prior to leaving the hospital.

Potential post-surgical complications for common procedures: 

Tumor removal: bleeding from surgical site, infection of surgical site, recurrence of tumor, suture reaction 

Neuter: bleeding from surgical site, infection & swelling of surgical site, suture reaction, weight gain, 

Spay: bleeding from surgical site, infection & swelling of surgical site, suture reaction, weight gain, urinary    incontinence, recurrent heat

We provide E-collars for pets that have had surgery to prevent them from licking at the surgical site, which will allow your pet to heal in the most ideal fashion.  If complications arise due to lack of proper use of the E-collar reparation is at the owner's expense.  

Note: Failure to be reached during the day may result in postponement of the procedure.

Additional procedures:

Certain procedures are easier to perform when a pet is anesthetized or sedated. Please check any of the following additional procedures you would like to have performed while your pet is anesthetized or sedated. Note that we will only perform these if it is safe to do so. Your pet’s safety is of utmost importance. 

Vaccines on request – not recommended – please speak to the coctor. Price varies per vaccine.