Surgery Consent Form (Under 7)

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Surgery Consent Form (Under 7)

Client's Name *

First

Last

Phone *

Email *

Pet's Name *

Date *

I hereby consent and authorize the performance of the following procedure(s) or operation(s). *

I am the owner or the agent for the owner of the animal and have the authority to execute this consent.

I authorize the use of appropriate anesthetics and other medications, and I understand that the veterinary technician will be emplyed as deemed necessary by the veterinarian. *

I agree (yes)

I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I understand that the results cannot be guaranteed. *

I agree (yes)

Anesthesia carries a risk of vomiting, which may lead to aspiration (fluid getting into the lungs), which can be fatal or otherwise severly impact pets' health. My pet was not fed since 8pm last night (unless otherwise directed by the veterinarian) *

I agree (yes)

Despite precautions that are undertaken when one of our patients undergo anesthetic procedures, rarely patients may have some emergency decompensation incident during such a procedure that may require cardiopulmonary resuscitation (CPR). Should such an emergency arise, I elect to have CPR performed in an attempt to revive my pet. I understand that additional costs may be incurred. *

I agree (yes)

Please select any additional options you would like to add

I wish to authorize pre-anesthetic bloodwork for my animal. Bloodwork is highly recommended for all animals about to undergo an anesthetic procedure. Bloodwork can detect early signs of health problems that may affect your pets' procedure. Pre-operation panel: $105.00
I wish to authorize a Pet Link microchip implant for pet identification. This implant is permanent and is good for the lifetime of the animal. The microchip: $57.00

I hereby authorize any necessary tooth extractions during my animals dental cleaning. Not all dental procedures require extractions. Dental x-rays will be performed before and after every extraction. *

I agree (yes)
I disagree (no)

(For dental procedures only)

Signature *

Clear Signature

I have read and understand this authorization and consent.

Date *

Surgery Consent Form (Under 7)

Surgery Consent Form (Under 7)

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