Anesthesia Consent Form

Pet Name: Client #:

Client Name:

The following document explains our recommended anesthesia treatment plan, to ensure the safe anesthetic induction and recovery of your pet while in our care. While some of these are optional, DesotoCounty Animal Clinic, P.A., must point out that all anesthesia involves inherent risk and that we will not be responsible for any complications of anesthesia which might have been avoided by accepting our recommendations.

If your pet is in estrus, there will be an additional charge between $20.00 and $45.00 depending on the size of your pet. Please initial stating that you understand this.

Initial: ______

Pain Management

All pets anesthetized for procedures deemed to be painful by the attending doctor will be treated for pain at your expense on an as needed basis. The staff will attempt to contact you if multiple injections are needed. The cost of each injection is $18.00-$22.00. Pain control may not be declined while your pet is in our care.

Additionally, we offer pain medications to go home after surgery to keep your pet from unnecessary pain on the day(s) following his or her procedure. Pain control medication (Send Home) is usually a tablet or oral liquid that will reduce pain and swelling after the procedure. The cost varies depending on your pet’s size and needs, but is usually $10.00-$25.00. Please sign below to accept or decline Send Home pain management for your pet.

Accept: ______

Decline: ______

Pre-Anesthetic Bloodwork

Sedatives and anesthetics must be metabolized by your pet through internal organs such as the liver and kidneys. Many pets that appear to be healthy have underlying disease that may interfere with the function of the organs. We strongly suggest allowing our staff to test your pet before anesthesia. Level 1 blood work is a basic panel, while Level 2 is greatly preferred to get a more complete picture of your pet’s ability to recover from the affects of anesthesia. Bloodwork is required for some procedures and for all procedures for pets over 7 years of age. Please sign below to accept or decline Pre-Anesthetic Bloodwork for your pet.

Accept Level 1($38.00): ______

Accept Level 2($57.00): ______

Decline: ______

Fluid Therapy

During your pet’s procedure, his or her metabolism will alter from normal dramatically. By placing an intravenous (I.V.) catheter, we are able to have access to your pet’s vascular system to allow our doctors to quickly administer medications that might be difficult or impossible to administer under emergency circumstances should a complication arise. Additionally, fluid therapy administered during surgery will help maintain normal blood pressure and to recover more quickly from the effects of anesthetic medications. We STRONGLY recommend fluid therapy for your pet during any anesthetic procedure. Fluids are required for some procedures and for all procedures for pets over 7 years of age.

Please sign below to accept or decline Fluid Therapy for your pet.

Accept($36.00): ______

Decline: ______

Laser Surgery

Use of a CO-2 Laser during your pet’s surgical procedure offers several advantages over traditional surgical techniques.

  • Less bleeding due to the sealing of small blood vessels in the surgical field.
  • Less initial pain due to sealing of small nerves in the surgical field.

The cost of the laser is $44.00 for each procedure used, with additional procedures done during the same anesthetic period billed at a prorated amount. We recommend laser for procedures such as canine neuters, canine and feline spays, mastectomies, mass removals, etc. Laser is required for some surgeries. Please sign below to accept or decline Laser Surgery.

Accept: ______

Decline: ______

Elizabethan Collar

We recommend that your pet be sent home with an Elizabethan collar and that your pet wear this collar for ten days. Complications of surgery can include infection, wound dehiscence or chewing out of sutures. The cost of the Elizabethan collar is between $14.25-$18.95. Please sign below to accept or decline an Elizabethan collar.

Accept: ______

Decline: ______

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* Trim My Pets Nails ____ Regular ($9.50) ____ Dremel ($14.00) ___ No Thanks

* Clean My Pet’s Ears ______($12.50) ______No Thanks

* Micro-Chip My Pet ______($45.99, $17.99 reg) ______No Thanks

* Scale and Polish My Pet’s Teeth ____Price based on stage ____ No Thanks

Other Services to be performed while my pet is sedated: ______

SPECIAL NOTE:

If your pet is too fractious or aggressive to allow a thorough physical exam or pre-anesthetic bloodwork or intravenous (I.V.) fluid administration before a sedative or anesthetic agent is administered, the risks for adverse reactions, including death, are significantly increased. We strive to give the safest, lowest dose possible to allow safe handling of your pet. Unfortunately, for pets with certain undetected or undiagnosed diseases, even low doses can cause serious adverse effects, including death.

I have read the above disclosures and options and understand there are inherent risks involved in any anesthetic procedure. I hereby release Desoto County Animal Clinic to use anesthesia on my pet.

Client Signature: ______

Phone Number Where You Can Be Reached Today: ______

Date: ______